Provider Demographics
NPI:1447333620
Name:TYLER, LESTER LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:LESTER
Middle Name:LEE
Last Name:TYLER
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 1:819 N DAN JONES RD
Mailing Address - Street 2:XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-9631
Mailing Address - Country:US
Mailing Address - Phone:317-838-7260
Mailing Address - Fax:
Practice Address - Street 1:1518 S 3RD ST
Practice Address - Street 2:XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-1012
Practice Address - Country:US
Practice Address - Phone:812-232-2557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007184A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist