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DR. TYLEN K HADERLIE DDS
NPI 1558711010
Dentist in Knoxville, TN

Active since June 15, 2016
5315 FOUNTAIN RD STE A, KNOXVILLE, TN 37918(865) 687-6763(865) 688-8503 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 11, 2025, Jun 26, 2024, Jul 21, 2022 and 2 more (5 updates tracked since 2016).

About Dr. Tylen K Haderlie Dds NPPES

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

DR. TYLEN K HADERLIE DDS (NPI 1558711010) is an individual dentist in Knoxville, Tennessee, licensed in Missouri (2016017398) and active in the NPI registry since June 2016. He maintains a secondary practice location in Fort Drum.

NPPES Registry Identity

NPI1558711010
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameDR. TYLEN K HADERLIECredential: DDS
Location Address5315 FOUNTAIN RD STE AKnoxville, TN 37918-3094
Mailing Address5315 Fountain Rd Ste AKnoxville, TN 37918-3094 · (865) 687-6763 · Fax (865) 688-8503
Phone(865) 687-6763
Fax(865) 688-8503
Sole ProprietorNo
Enumeration DateJune 15, 2016
Last NPPES UpdateSeptember 11, 20255 updates tracked since enumeration
NPPES CertifiedJune 26, 2024
✔ NPI 1558711010 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in MO · 2016017398
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
5315 FOUNTAIN RD STE A, Knoxville, TN 37918
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Secondary Practice Location 1

Location 110205 N Riva Ridge LoopFort Drum, NY 13602-5457 · Phone (315) 772-6234

Accepted Insurance

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

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 Tylen Haderlie's NPI number?

The NPI number for Tylen Haderlie is 1558711010. It was assigned to this individual provider in the NPPES registry on June 15, 2016.

Where is Tylen Haderlie located?

Tylen Haderlie practices at 5315 Fountain Rd Ste A, Knoxville, TN 37918. The listed phone number is (865) 687-6763.

What is Tylen Haderlie's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

What insurance does Tylen Haderlie accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and BlueCross BlueShield of Tennessee list Tylen Haderlie 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 Tylen Haderlie was last updated on September 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months 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.