Provider Demographics
NPI:1568162733
Name:TYLER FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:TYLER FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-380-0127
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:MN
Mailing Address - Zip Code:56178-0366
Mailing Address - Country:US
Mailing Address - Phone:507-247-5591
Mailing Address - Fax:
Practice Address - Street 1:197 N TYLER ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:MN
Practice Address - Zip Code:56178-1160
Practice Address - Country:US
Practice Address - Phone:507-247-5591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center