Provider Demographics
NPI:1316202328
Name:ALLERDING, TYLER NEWTON (DDS)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:NEWTON
Last Name:ALLERDING
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 1:1 WATER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-1810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:989 W WASHINGTON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4064
Practice Address - Country:US
Practice Address - Phone:906-226-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010207541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice