Individual
TREY JACKSON THYGERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
920 S HOVER ST, LONGMONT, CO 80501-7900
(303) 485-8888
Mailing address
388 ELLIE WAY, BERTHOUD, CO 80513-2820
(970) 412-8050
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEN.00204730
CO
Other
Enumeration date
06/02/2021
Last updated
06/02/2021
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