Healthcare Provider Details

I. General information

NPI: 1699632018
Provider Name (Legal Business Name): TYLER JESTIN HURST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

IV. Provider business mailing address

2513 S 3RD STREET PLZ
OMAHA NE
68108-1709
US

V. Phone/Fax

Practice location:
  • Phone: 920-431-2500
  • Fax:
Mailing address:
  • Phone: 208-360-0092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: