Provider Demographics
NPI:1033524434
Name:MELZER, TYLER (DMD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:MELZER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4265 FALLON ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6797
Mailing Address - Country:US
Mailing Address - Phone:406-587-7411
Mailing Address - Fax:406-587-2357
Practice Address - Street 1:4265 FALLON ST
Practice Address - Street 2:SUITE #2
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6797
Practice Address - Country:US
Practice Address - Phone:406-587-7411
Practice Address - Fax:406-587-2357
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-77941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice