Provider Demographics
NPI:1821140013
Name:TYLER, BRIAN GIBBS (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:GIBBS
Last Name:TYLER
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 1:936 PINE NEEDLE TRL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1034
Mailing Address - Country:US
Mailing Address - Phone:248-652-0318
Mailing Address - Fax:
Practice Address - Street 1:435 PINE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1933
Practice Address - Country:US
Practice Address - Phone:248-652-9116
Practice Address - Fax:248-652-3136
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist