Provider Demographics
NPI:1013780683
Name:SAXSMA, TYLER JAMES (DMD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:SAXSMA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6224
Mailing Address - Country:US
Mailing Address - Phone:847-804-5161
Mailing Address - Fax:
Practice Address - Street 1:9101 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-1804
Practice Address - Country:US
Practice Address - Phone:708-419-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0343701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice