Healthcare Provider Details

I. General information

NPI: 1477550952
Provider Name (Legal Business Name): MICHAEL R TINKLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 NICKLIN AVE
PIQUA OH
45356-1739
US

IV. Provider business mailing address

821 NICKLIN AVE
PIQUA OH
45356-1739
US

V. Phone/Fax

Practice location:
  • Phone: 937-778-1623
  • Fax: 937-778-0359
Mailing address:
  • Phone: 937-778-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number30-012784
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: