Provider Demographics
NPI:1801535745
Name:LAUREL, TYLER JAMAL (DDS, MA)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JAMAL
Last Name:LAUREL
Suffix:
Gender:M
Credentials:DDS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PARK AVENUE
Mailing Address - Street 2:HENNEPIN COUNTY MEDICAL CENTER - DENTAL & ORAL SURGERY
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415
Mailing Address - Country:US
Mailing Address - Phone:612-873-3000
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVENUE
Practice Address - Street 2:HENNEPIN COUNTY MEDICAL CENTER - DENTAL & ORAL SURGERY
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415
Practice Address - Country:US
Practice Address - Phone:612-873-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program