Clark, Tyler Lee
Clark, Tyler Lee is an individual health care provider with primary practice located at 330 S Garden Way Ste 140, Eugene OR 97401-8176. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Clark, Tyler Lee can be contacted via phone (541) 686-9750.Contact Information
Primary practice address
330 S Garden Way Ste 140
Eugene OR 97401-8176
Phone: (541) 686-9750
Fax: (541) 485-5034
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | D10177 | Oregon |
Profile Details
| NPI number | 1578542361 |
|---|---|
| LBN Legal business name | Clark, Tyler Lee |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 11th, 2006 |
| Last updated | Jan 11th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578542361 | NPPES |
| Oregon | MEDICAID | 500684192 |
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