Provider Demographics
NPI:1295870442
Name:TYLER, CHRISTOPHER M (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:M
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 1:1601 BOYSON SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2311
Mailing Address - Country:US
Mailing Address - Phone:319-366-8095
Mailing Address - Fax:319-366-4542
Practice Address - Street 1:1601 BOYSON SQUARE DR
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2311
Practice Address - Country:US
Practice Address - Phone:319-366-8095
Practice Address - Fax:319-366-4542
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7841122300000X, 1223G0001X
IA08330122300000X
IA8012122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1386709772Medicaid
IA1376619965Medicaid