Tyler Paul Bergien, DDS
Individual provider Active NPI General Practice Dentistry · Jackson, WY
NPI 1669683025 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1669683025
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- #1004 (WY)
- Practice address
- 945 W Broadway
Suite #201
Jackson, WY 83001 - Phone
- (307) 734-5200
- Fax
- (307) 733-2922
- NPI assigned
- May 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150729008414 | WY | Order and Referring Only - Dentist |
7517271901 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| #1004 | WY | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | #1004 | WY | Yes |
Addresses
Primary practice location
945 W Broadway
Suite #201
Jackson, WY 83001
Mailing address
945 W Broadway
Suite 201,P O Box 11779
Jackson, WY 83001
Phone (307) 734-5200
Other providers in Jackson, WY
- Jamie Bennett
- Katherine Benson
- Katie Hogan Benson
- Andrea Bent
- Katharine Bergart
- Brett Gordon Bernard
- Hannah R Bernier
- Laura-Lee Berrett
- Kevin Bias
- Chandler Billingham
All providers in Jackson, WY · General Practice Dentistry in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.