Individual
DR. TYLER J KOIVISTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1430 HIGHWAY 96, WHITE BEAR LAKE, MN 55110
(651) 426-9502
(651) 653-2158
Mailing address
1430 HIGHWAY 96, WHITE BEAR LAKE, MN 55110
(651) 426-9502
(651) 653-2158
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D13236
MN
Other
Enumeration date
06/12/2013
Last updated
07/21/2022
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