Individual ProviderNicole TyszkowskiDentistDental ProvidersPractice Address2995 Clairemont Dr Ste A, San Diego, CA 92117-6766(858) 200-0827(773) 968-9880PECOS EnrollmentBased on the most recent information from CMS, provider Nicole Tyszkowski does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1730866344Provider TypeIndividualFull NameTyszkowski, NicoleCredentialDMDGenderFemaleSole ProprietorYesEnumeration Date7/5/2023Last Updated8/15/2025Contact InformationPractice LocationPractice Address2995 Clairemont Dr Ste A, San Diego, CA 92117-6766Phone(858) 200-0827FaxUnlisted FaxMailing LocationMailing Address1140 Hickory Trail, Downers Grove, IL 60515Phone(773) 968-9880FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode122300000XPrimaryDescriptionDentistDental ProvidersLicense111336California