Individual
DR. TYLER K. NIVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1101 N PROVIDENCE RD, COLUMBIA, MO 65203-4365
(573) 886-6711
(573) 814-2784
Mailing address
1001 W WORLEY ST, COLUMBIA, MO 65203-2037
(573) 886-6711
(573) 814-2784
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2009015884
MO
Other
Enumeration date
06/18/2009
Last updated
06/18/2009
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