Individual
DR. THOMAS WILLIAM TYLKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1400 STATE ROUTE F, WAYNESVILLE, MO 65583-2831
(573) 774-6101
(573) 774-6812
Mailing address
1400 STATE ROUTE F, WAYNESVILLE, MO 65583-2831
(573) 774-6101
(573) 774-6812
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019-018811
IL
1223G0001X
General Practice Dentistry
Primary
2005037081
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T135072040
DRIVER LICENSE
MO
Enumeration date
12/22/2005
Last updated
10/19/2011
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