Provider Demographics
NPI:1316021264
Name:GLASER, TYLER A (DDS)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:A
Last Name:GLASER
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 1:24 BROWN BLVD
Mailing Address - Street 2:
Mailing Address - City:ROTHSCHILD
Mailing Address - State:WI
Mailing Address - Zip Code:54474
Mailing Address - Country:US
Mailing Address - Phone:715-359-4344
Mailing Address - Fax:715-359-7733
Practice Address - Street 1:24 BROWN BLVD
Practice Address - Street 2:
Practice Address - City:ROTHSCHILD
Practice Address - State:WI
Practice Address - Zip Code:54474
Practice Address - Country:US
Practice Address - Phone:715-359-4344
Practice Address - Fax:715-842-4369
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5071WI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice