Provider Demographics
NPI:1013619188
Name:CLAUSEN, TYLER (DMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:CLAUSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 FAIRVIEW RD STE B
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7495
Mailing Address - Country:US
Mailing Address - Phone:864-881-7098
Mailing Address - Fax:
Practice Address - Street 1:668 FAIRVIEW RD STE B
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7495
Practice Address - Country:US
Practice Address - Phone:864-881-7098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN5061122300000X
SC110341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist