Tyler Kalmuck, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

1002255-15 Issued in WI

Practice address

3637 Wilgus Ave
Sheboygan, WI 53081-3050

Phone

(920) 458-8213

Fax

(920) 459-9797

NPI assigned

May 16, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2023 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1463356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1063869485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3637 WILGUS AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530813050",
            "telephone_number": "920-458-8213",
            "fax_number": "920-459-9797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3637 WILGUS AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530813050",
            "telephone_number": "920-458-8213",
            "fax_number": "920-459-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KALMUCK",
        "first_name": "TYLER",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-16",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WI",
            "license": "1002255-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Just Kids Dental SC
• Jesse Michael Justus, D.O.
• Jonathan J Kabat, PTA
• Heba Kalaji, MD
• Jennifer Ann Kalista, LPC
• Kara Ann Kaltenbrun, DDS
• Amy Lynn Kamien, PHARMD
• Steven Kenneth Kanter, M.D.
• Mary J Kao, MD
• Mazal Karan, MS, CCC-SLP

• Oral and Maxillofacial Surgery (Dentist) in Sheboygan, WI
• Providers in Sheboygan, WI by specialty
• Oral and Maxillofacial Surgery (Dentist) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.