Organization
LIFT DENTAL PLLC
Active
Other names
Artistic Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TREY JACKSON THYGERSON DDS (DENTIST)
(303) 485-8888
Entity
Organization
Contact information
Practice address
920 S HOVER ST, LONGMONT, CO 80501-7900
(303) 485-8888
Mailing address
920 S HOVER ST, LONGMONT, CO 80501-7900
(303) 485-8888
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730755430
—
CO
Enumeration date
12/30/2021
Last updated
12/30/2021
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