Individual
TYLER MADAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6145 DESERT STORM AVE, FORT CAMPBELL, KY 42223-5558
(270) 412-2787
Mailing address
6145 DESERT STORM AVE, FORT CAMPBELL, KY 42223-5558
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901601300
MI
390200000X
Student in an Organized Health Care Education/Training Program
2901601300
MI
Other
Enumeration date
07/26/2022
Last updated
06/30/2023
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