Basic Information
| Provider Information | |||||||||
| NPI: | 1801535745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAUREL | ||||||||
| FirstName: | TYLER | ||||||||
| MiddleName: | JAMAL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS, MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 PARK AVENUE | ||||||||
| Address2: | HENNEPIN COUNTY MEDICAL CENTER - DENTAL & ORAL SURGERY | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128733000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 PARK AVENUE | ||||||||
| Address2: | HENNEPIN COUNTY MEDICAL CENTER - DENTAL & ORAL SURGERY | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128733000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2022 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.