Provider Demographics
NPI:1023224342
Name:TYGESEN, YANCY A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:YANCY
Middle Name:A
Last Name:TYGESEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2395 JOLLY RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3662
Mailing Address - Country:US
Mailing Address - Phone:517-347-7777
Mailing Address - Fax:517-347-2037
Practice Address - Street 1:2395 JOLLY RD
Practice Address - Street 2:SUITE 130
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3662
Practice Address - Country:US
Practice Address - Phone:517-347-7777
Practice Address - Fax:517-347-2037
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010166611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics