Provider Demographics
NPI:1043684079
Name:SERVER, TYLER (DH)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:SERVER
Suffix:
Gender:M
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 W SILVER SPRING DR
Mailing Address - Street 2:MILWAUKEE HEALTH SERVICES, INC.
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-2552
Mailing Address - Country:US
Mailing Address - Phone:414-760-3900
Mailing Address - Fax:414-464-7258
Practice Address - Street 1:8200 W SILVER SPRING DR
Practice Address - Street 2:MILWAUKEE HEALTH SERVICES, INC.
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-2552
Practice Address - Country:US
Practice Address - Phone:414-760-3900
Practice Address - Fax:414-464-7258
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11554-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist