Provider Demographics
NPI:1467114025
Name:KOUPAL, TYLER JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JOSEPH
Last Name:KOUPAL
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 1:4110 W 47TH TER
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1334
Mailing Address - Country:US
Mailing Address - Phone:605-988-4209
Mailing Address - Fax:
Practice Address - Street 1:319 NE VIVION RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4510
Practice Address - Country:US
Practice Address - Phone:816-459-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA099481223G0001X
MO20220464281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice