Provider Demographics
NPI:1235864075
Name:THALMANN, TREY RIKIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:TREY
Middle Name:RIKIO
Last Name:THALMANN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 MESA TOP DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-7968
Mailing Address - Country:US
Mailing Address - Phone:310-808-3669
Mailing Address - Fax:
Practice Address - Street 1:1295 E LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1703
Practice Address - Country:US
Practice Address - Phone:626-287-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-17
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109472122300000X
CO00205153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist