Provider Demographics
NPI:1336808542
Name:TYLER VENEMAN DDS, PLLC
Entity Type:Organization
Organization Name:TYLER VENEMAN DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:VENEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-808-7863
Mailing Address - Street 1:12715 W M 179 HWY
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-9318
Mailing Address - Country:US
Mailing Address - Phone:616-808-7863
Mailing Address - Fax:
Practice Address - Street 1:12715 W M 179 HWY
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-9318
Practice Address - Country:US
Practice Address - Phone:616-808-7863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental