Provider Demographics
NPI:1942825252
Name:TRAN, TYLER ALAN (DMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:ALAN
Last Name:TRAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:MR
Other - First Name:TYLER
Other - Middle Name:ALAN
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1624 S DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-5780
Mailing Address - Country:US
Mailing Address - Phone:269-628-8770
Mailing Address - Fax:
Practice Address - Street 1:1624 S DRAKE RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-5780
Practice Address - Country:US
Practice Address - Phone:269-628-8770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016004751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice