Provider Demographics
NPI:1639728504
Name:TYLER E BAUER DMD PC
Entity Type:Organization
Organization Name:TYLER E BAUER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-966-7350
Mailing Address - Street 1:1021 S 40TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3880
Mailing Address - Country:US
Mailing Address - Phone:509-966-7350
Mailing Address - Fax:
Practice Address - Street 1:1021 S 40TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3880
Practice Address - Country:US
Practice Address - Phone:509-966-7350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment