Provider Demographics
NPI:1619028800
Name:TRYLOVICH, GIFFORD, LTD.
Entity type:Organization
Organization Name:TRYLOVICH, GIFFORD, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TRYLOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:702-259-1943
Mailing Address - Street 1:3811 W CHARLESTON BLVD
Mailing Address - Street 2:#201
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1846
Mailing Address - Country:US
Mailing Address - Phone:702-259-1943
Mailing Address - Fax:702-877-2727
Practice Address - Street 1:3811 W CHARLESTON BLVD
Practice Address - Street 2:#201
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1846
Practice Address - Country:US
Practice Address - Phone:702-259-1943
Practice Address - Fax:702-877-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV51031223P0300X
NV26351223P0300X
NV65071223P0300X
NV27071223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty