Provider Demographics
NPI:1487787057
Name:FAULKNER, TYLER L (DDS)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:L
Last Name:FAULKNER
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 1:3225 ORO DAM BLVD E
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-5219
Mailing Address - Country:US
Mailing Address - Phone:530-533-7400
Mailing Address - Fax:530-533-7408
Practice Address - Street 1:3225 ORO DAM BLVD E
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5219
Practice Address - Country:US
Practice Address - Phone:530-533-7400
Practice Address - Fax:530-533-7408
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35718122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist