Healthcare Provider Details

I. General information

NPI: 1083181531
Provider Name (Legal Business Name): MICHAEL L. TYLER DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N MAIN ST
MT PLEASANT TN
38474-1015
US

IV. Provider business mailing address

703 N MAIN ST
MT PLEASANT TN
38474-1015
US

V. Phone/Fax

Practice location:
  • Phone: 931-379-7711
  • Fax: 931-379-7729
Mailing address:
  • Phone: 931-379-7711
  • Fax: 931-379-7729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL L TYLER
Title or Position: OWNER
Credential: DDS
Phone: 931-379-7711