Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2901018861 | MI |
NPI | 1023222882 |
---|---|
Provider Name | Dr. Erika June Tyler |
First Address | Staten Island, NY 10305-3528 |
Second Address | Marquette, MI 49855-4064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |