Provider Demographics
NPI:1699268540
Name:ALDERMAN, TYLER GRANT (DDS)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:GRANT
Last Name:ALDERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TY
Other - Middle Name:GRANT
Other - Last Name:ALDERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:555 ALDERLY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461
Mailing Address - Country:US
Mailing Address - Phone:304-617-8383
Mailing Address - Fax:
Practice Address - Street 1:124 S GOOSE CREEK BLVD STE D
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3136
Practice Address - Country:US
Practice Address - Phone:843-261-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist