Provider Demographics
NPI:1346085362
Name:OPIELA, TYLER JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JOHN
Last Name:OPIELA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 S HARTMANN DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-4779
Mailing Address - Country:US
Mailing Address - Phone:615-453-9937
Mailing Address - Fax:
Practice Address - Street 1:335 S HARTMANN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-4779
Practice Address - Country:US
Practice Address - Phone:615-453-9937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN125691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice