Provider Demographics
NPI:1174364509
Name:OSTERDAY, TYLER ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ALAN
Last Name:OSTERDAY
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 1:12797 REDBIRD RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-9610
Mailing Address - Country:US
Mailing Address - Phone:262-470-1245
Mailing Address - Fax:
Practice Address - Street 1:206 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:CUBA CITY
Practice Address - State:WI
Practice Address - Zip Code:53807-1147
Practice Address - Country:US
Practice Address - Phone:262-470-1245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001522-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice