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DR. DUTRAN TYLER DO MD, DMD
NPI 1053490961
Oral & Maxillofacial Surgery in Los Angeles, CA

Active since November 02, 2006PECOS Enrolled
12401 WILSHIRE BLVD STE 104, LOS ANGELES, CA 90025(203) 200-7280 Get Directions Write a Review

NPPES record last updated: February 27, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 27, 2022, Feb 16, 2016 (2 updates tracked since 2016).

About Dr. Dutran Tyler Do Md, Dmd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DUTRAN TYLER DO MD, DMD (NPI 1053490961) is an individual oral & maxillofacial surgery provider in Los Angeles, California, licensed in California (C139636) and active in the NPI registry since November 2006. He is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1053490961
Entity TypeIndividualMale
Primary Taxonomy204E00000X
Provider Legal NameDR. DUTRAN TYLER DOCredential: MD, DMD
Location Address12401 WILSHIRE BLVD STE 104Los Angeles, CA 90025-1015
Mailing Address12401 Wilshire Blvd Ste 104Los Angeles, CA 90025-1015 · (203) 200-7280
Phone(203) 200-7280
Sole ProprietorYes
Enumeration DateNovember 2, 2006
Last NPPES UpdateFebruary 27, 20222 updates tracked since enumeration
NPPES CertifiedFebruary 27, 2022
✔ NPI 1053490961 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOral & Maxillofacial SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code204E00000X
Licenses✔ Licensed in CA · C139636✔ Licensed in CT · 049194✔ Licensed in NY · 257471
Definition
Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.
Also ListedDentistTaxonomy 122300000X · License 052760 (NY), 64626 (CA)
12401 WILSHIRE BLVD STE 104, Los Angeles, CA 90025
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Secondary Practice Locations 2

Location 16505 Rosemead Blvd Ste 203Pico Rivera, CA 90660-3543 · Phone (562) 942-1062
Location 27901 BroadwayElmhurst, NY 11373-1329 · Phone (718) 334-4000

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Dutran Tyler Do Md, Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AVANTIS NEUROSCIENCE INC
Psychiatry & Neurology (Clinical Neurophysiology)
12401 WILSHIRE BLVD STE 104
LOS ANGELES, CA 90025
Los Angeles County (323) 682-0182
KEVIN JOHN DE COMINES L.AC.
Acupuncturist
12401 WILSHIRE BLVD STE 104
LOS ANGELES, CA 90025
Los Angeles County (310) 826-2021

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dutran Do's NPI number?

The NPI number for Dutran Do is 1053490961. It was assigned to this individual provider in the NPPES registry on November 2, 2006.

Where is Dutran Do located?

Dutran Do practices at 12401 Wilshire Blvd Ste 104, Los Angeles, CA 90025. The listed phone number is (203) 200-7280.

What is Dutran Do's specialty?

The primary specialty registered for this NPI is Oral & Maxillofacial Surgery with taxonomy code 204E00000X.

Is Dutran Do enrolled in Medicare?

Yes. Dutran Do is registered in the Medicare PECOS enrollment system.

What insurance does Dutran Do accept?

Health plans from BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Florida Combined Life and 4 other insurers list Dutran Do as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Dutran Do was last updated on February 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.