Healthcare Provider Details

I. General information

NPI: 1619028800
Provider Name (Legal Business Name): TRYLOVICH, GIFFORD, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 W CHARLESTON BLVD #201
LAS VEGAS NV
89102-1846
US

IV. Provider business mailing address

3811 W CHARLESTON BLVD #201
LAS VEGAS NV
89102-1846
US

V. Phone/Fax

Practice location:
  • Phone: 702-259-1943
  • Fax: 702-877-2727
Mailing address:
  • Phone: 702-259-1943
  • Fax: 702-877-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number5103
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2635
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6507
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2707
License Number StateNV

VIII. Authorized Official

Name: DR. DAVID JAMES TRYLOVICH
Title or Position: OWNER
Credential: D.D.S., M.S.
Phone: 702-259-1943