Provider Demographics
NPI:1083181531
Name:MICHAEL L. TYLER DDS
Entity Type:Organization
Organization Name:MICHAEL L. TYLER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-379-7711
Mailing Address - Street 1:703 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:TN
Mailing Address - Zip Code:38474-1015
Mailing Address - Country:US
Mailing Address - Phone:931-379-7711
Mailing Address - Fax:931-379-7729
Practice Address - Street 1:703 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TN
Practice Address - Zip Code:38474-1015
Practice Address - Country:US
Practice Address - Phone:931-379-7711
Practice Address - Fax:931-379-7729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental