Provider Demographics
NPI:1407681406
Name:TYAGI, ANKUR KUMAR (DMD)
Entity type:Individual
Prefix:
First Name:ANKUR
Middle Name:KUMAR
Last Name:TYAGI
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 1:451 WESTCLIFFE BLVD APT C219
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9323
Mailing Address - Country:US
Mailing Address - Phone:205-734-5758
Mailing Address - Fax:
Practice Address - Street 1:451 WESTCLIFFE BLVD APT C219
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9323
Practice Address - Country:US
Practice Address - Phone:205-734-5758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61590368122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist