MEDICARE: TYLER JON RAMIR DMD

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	1223G0001X	General Practice Dentistry	019031887	IL

General Provider Information

NPI Number	:	1720562895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER JON RAMIR DMD

Provider Business Mailing Address
First Line	:	17W440 HICKORY AVE
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-7735
Country	:	US
Telephone Number	:	312-203-6139
Fax Number	:

Provider Business Practice Location Address
First Line	:	5160 S PULASKI RD STE 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-4253
Country	:	US
Telephone Number	:	773-977-7088
Fax Number	:

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

Provider Enumeration Date	:	09/24/2018
Last Update Date	:	09/24/2018

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