MEDICARE: GINA MARIE TRICHAK RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	000904991	CO

General Provider Information

NPI Number	:	1801360383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MARIE TRICHAK RDH

Provider Business Mailing Address
First Line	:	835 E PLATTE AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3547
Country	:	US
Telephone Number	:	719-755-0155
Fax Number	:

Provider Business Practice Location Address
First Line	:	835 E PLATTE AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3547
Country	:	US
Telephone Number	:	719-229-0747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2019
Last Update Date	:	04/12/2026

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