Basic Information
| Provider Information | |||||||||
| NPI: | 1386694644 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TYLER | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3551 ROGER BROOKE DR DEPT OF | ||||||||
| Address2: | |||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782344504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109161843 | ||||||||
| FaxNumber: | 2109163235 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 WILFORD HALL LOOP BLDG WILFORD | ||||||||
| Address2: | |||||||||
| City: | JBSA LACKLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782365638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109161843 | ||||||||
| FaxNumber: | 2109163235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0106X | 047716 | NY | Y | Dental Providers | Dentist | Oral and Maxillofacial Pathology |
No ID Information.