Provider Demographics
NPI:1063869485
Name:KALMUCK, TYLER (DDS)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:KALMUCK
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 1:3637 WILGUS AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3050
Mailing Address - Country:US
Mailing Address - Phone:920-458-8213
Mailing Address - Fax:920-459-9797
Practice Address - Street 1:3637 WILGUS AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3050
Practice Address - Country:US
Practice Address - Phone:920-458-8213
Practice Address - Fax:920-459-9797
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002255-151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery