Provider Demographics
NPI:1356754170
Name:SARAZIN, TYLER (DDS)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:SARAZIN
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 1:528 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1846
Mailing Address - Country:US
Mailing Address - Phone:906-482-8601
Mailing Address - Fax:906-482-9953
Practice Address - Street 1:528 QUINCY ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1846
Practice Address - Country:US
Practice Address - Phone:906-482-8601
Practice Address - Fax:906-482-9953
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist