Provider Demographics
NPI:1770511750
Name:TYCOLIZ, WILLIAM L JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:TYCOLIZ
Suffix:JR
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:P.O. BOX 212
Mailing Address - Street 2:24986 OVERSEAS HIGHWAY
Mailing Address - City:SUMMERLAND KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042
Mailing Address - Country:US
Mailing Address - Phone:305-745-1522
Mailing Address - Fax:305-745-1753
Practice Address - Street 1:24986 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:SUMMERLAND KEY
Practice Address - State:FL
Practice Address - Zip Code:33042-4612
Practice Address - Country:US
Practice Address - Phone:305-745-1522
Practice Address - Fax:305-745-1753
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN113891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL67722OtherBC/BS OF FLORIDA
FLD101611OtherCIGNA DENTAL HEALTH PROVI
FL995507OtherCOMPBENEFITS PROVIDER
PA513635OtherUNITED CONCORDIA PROVIDER