Provider Demographics
NPI:1972953511
Name:EHRICK, TYLER ROSS (DMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ROSS
Last Name:EHRICK
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 1:3807 W PHELPS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2858
Mailing Address - Country:US
Mailing Address - Phone:602-697-2812
Mailing Address - Fax:
Practice Address - Street 1:8253 W THUNDERBIRD RD
Practice Address - Street 2:STE 101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4616
Practice Address - Country:US
Practice Address - Phone:623-412-2439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0095001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice