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DR. TYLER KELLUM LEVIE D.D.S.
>> Dentist >> Dental ProvidersRegistrant NPI Number: 1023484805
Individual Registrant:DR. TYLER KELLUM LEVIE D.D.S.
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
201 E. VILLANOW STREET LAFAYETTE, GA 30728 US
Tel: 706-638-2784 Fax: 706-638-7428
Tel: 706-638-2784 Fax: 706-638-7428
Contact information for business:
201 E. VILLANOW STREET LAFAYETTE, GA 30728 US
Tel: 706-638-2784 Fax: 706-638-7428
Tel: 706-638-2784 Fax: 706-638-7428
Registration Information:
NPI: 1023484805
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 122300000X | Dental Providers Dentist | GA | DN015053 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
