Basic Information
| Provider Information | |||||||||
| NPI: | 1003301458 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORN | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | RAY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1419 COPPERCREST DR | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773862565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3282823328 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9595 SIX PINES DR STE 1370 | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773801540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812982433 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2018 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 34117 | TX | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 34117 | 01 | TX | TSBDE | OTHER |