Provider Demographics
NPI:1245594175
Name:CHRISTOPHERSON, TYLER C (DDS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:C
Last Name:CHRISTOPHERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 E MARIA DR
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1334
Mailing Address - Country:US
Mailing Address - Phone:715-342-8060
Mailing Address - Fax:715-342-0062
Practice Address - Street 1:3504 E MARIA DR
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1334
Practice Address - Country:US
Practice Address - Phone:715-342-8060
Practice Address - Fax:715-342-0062
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6947-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist