Provider Demographics
NPI:1154996601
Name:ROLLAND, TYLER ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ALLEN
Last Name:ROLLAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29200 S 4130 RD
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-6224
Mailing Address - Country:US
Mailing Address - Phone:918-606-2757
Mailing Address - Fax:
Practice Address - Street 1:1950 W KENOSHA ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8944
Practice Address - Country:US
Practice Address - Phone:918-518-1526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK74291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice