| Tyler Bergien, DDS | |
|
945 W Broadway Ave Apt 201 Jackson WY 83001-8217 | |
| (307) 734-5200 | |
| (307) 733-2922 |
| Full Name | Tyler Bergien, DDS |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 945 W Broadway Ave Apt 201, Jackson, Wyoming |
| Authorized Official Name and Position | Kiffin Hansen (OFFICE MANAGER) |
| Authorized Official Contact | 3077345200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tyler Bergien, DDS Po Box 11779 Jackson WY 83002-1779 Ph: (307) 734-5200 | Tyler Bergien, DDS 945 W Broadway Ave Apt 201 Jackson WY 83001-8217 Ph: (307) 734-5200 |
| NPI Number | 1619503349 |
|---|---|
| Provider Enumeration Date | 03/13/2020 |
| Last Update Date | 03/13/2020 |
| Certification Date | 03/13/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619503349 | NPI | - | NPPES |
| 1669683025 | Other | WY | NPI TYPE 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | () | Primary |
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