Provider Demographics
NPI:1972648020
Name:TYLER, LISA W (DMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:W
Last Name:TYLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CEDAR AVE UNIT 12
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3192
Mailing Address - Country:US
Mailing Address - Phone:401-284-3500
Mailing Address - Fax:401-284-3502
Practice Address - Street 1:63 CEDAR AVE UNIT 12
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3192
Practice Address - Country:US
Practice Address - Phone:401-284-3500
Practice Address - Fax:401-284-3502
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI24941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics