Provider Demographics
NPI:1639280878
Name:MEYER, TYRA LOUISE (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:TYRA
Middle Name:LOUISE
Last Name:MEYER
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:MISS
Other - First Name:TYRA
Other - Middle Name:LOUISE
Other - Last Name:SCHMIESING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS MS
Mailing Address - Street 1:2969 BLUE JACKET COURT
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806
Mailing Address - Country:US
Mailing Address - Phone:419-229-3007
Mailing Address - Fax:419-229-0214
Practice Address - Street 1:2969 BLUE JACKET COURT
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806
Practice Address - Country:US
Practice Address - Phone:419-229-3007
Practice Address - Fax:419-229-0214
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300203251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2354429Medicaid