MEDICARE: DR. TYLER JAMES SCHUURMANS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	D14852	MN

General Provider Information

NPI Number	:	1366674418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER JAMES SCHUURMANS D.D.S.

Provider Business Mailing Address
First Line	:	1420 LAKE ST S # 200A
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-2703
Country	:	US
Telephone Number	:	651-464-9888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 LAKE ST S # 200A
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-2703
Country	:	US
Telephone Number	:	651-464-9888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2009
Last Update Date	:	04/11/2024

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