MEDICARE: DR. MICHAEL L TYLER DDS

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	4217	TN

General Provider Information

NPI Number	:	1902909385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL L TYLER DDS

Provider Business Mailing Address
First Line	:	703 NORTH MAIN STREET
Second Line	:
City	:	MT PLEASANT
State	:	TN
Zip	:	38474-1015
Country	:	US
Telephone Number	:	931-379-7711
Fax Number	:	931-379-7729

Provider Business Practice Location Address
First Line	:	703 NORTH MAIN STREET
Second Line	:
City	:	MT PLEASANT
State	:	TN
Zip	:	38474-1015
Country	:	US
Telephone Number	:	931-379-7711
Fax Number	:	931-379-7729

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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