Provider Demographics
NPI:1235315888
Name:TYLER, JERAL
Entity type:Individual
Prefix:
First Name:JERAL
Middle Name:
Last Name:TYLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:MD
Mailing Address - Zip Code:20754-2735
Mailing Address - Country:US
Mailing Address - Phone:301-327-5086
Mailing Address - Fax:301-327-5088
Practice Address - Street 1:2975 PLAZA DR
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-2735
Practice Address - Country:US
Practice Address - Phone:301-327-5086
Practice Address - Fax:301-327-5088
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist