Healthcare Provider Details

I. General information

NPI: 1174364509
Provider Name (Legal Business Name): TYLER ALAN OSTERDAY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 PERFORMANCE DR
DARLINGTON WI
53530-9393
US

IV. Provider business mailing address

133 PERFORMANCE DR
DARLINGTON WI
53530-9393
US

V. Phone/Fax

Practice location:
  • Phone: 608-776-2443
  • Fax: 608-776-2448
Mailing address:
  • Phone: 608-776-2443
  • Fax: 608-776-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6001522-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: