Provider Demographics
NPI:1154833044
Name:DAVIS, TYLER MEADOWS (DDS)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:MEADOWS
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N161W20685 KAMI LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037-8937
Mailing Address - Country:US
Mailing Address - Phone:262-622-1571
Mailing Address - Fax:
Practice Address - Street 1:1201 OAK ST STE D
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3800
Practice Address - Country:US
Practice Address - Phone:262-310-1860
Practice Address - Fax:262-310-1861
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001705-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice