Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 34117 | TX |
NPI | 1003301458 |
---|---|
Provider Name | Dr. Tyler Ray Orn |
First Address | Spring, TX 77386-2565 |
Second Address | Spring, TX 77380-1540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2018 |
Last Update Date | 28/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34117 | TSBDE (01) | TX |