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General NPI Number Information
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NPI Number | 1649760612
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Entity Type | Individual
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Provider Name | TYLER MARK VENEMAN DDS
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Gender | Male
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 12715 W M 179 HWY
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City | WAYLAND
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State | MI
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Zip | 49348-9318
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Country | US
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Telephone | 269-792-9723
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Fax |
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Provider Business Mailing Address
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Address Line | 765 HAMPDEN AVE APT 136
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City | SAINT PAUL
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State | MN
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Zip | 55114-1664
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Country | US
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Telephone | 616-808-7863
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901022591
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License Number State | MI
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