| NPI | 1619503349 |
|---|---|
| Other Name | TYLER BERGIEN, DDS |
| Entity Type | Organization |
| Authorized Contact | KIFFIN HANSEN Office Manager 307-734-5200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2020-03-13 |