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General NPI Number Information
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NPI Number | 1366674418
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Entity Type | Individual
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Provider Name | TYLER JAMES SCHUURMANS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 1420 LAKE ST S # 200A
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City | FOREST LAKE
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State | MN
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Zip | 55025-2703
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Country | US
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Telephone | 651-464-9888
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 LAKE ST S # 200A
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City | FOREST LAKE
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State | MN
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Zip | 55025-2703
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Country | US
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Telephone | 651-464-9888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | D14852
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License Number State | MN
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