Provider Demographics
NPI:1497370209
Name:GIVEN, TREVOR WAYNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:WAYNE
Last Name:GIVEN
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 1:2993 S PEORIA ST STE 210
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-5707
Mailing Address - Country:US
Mailing Address - Phone:303-696-6979
Mailing Address - Fax:
Practice Address - Street 1:2993 S PEORIA ST STE 210
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5707
Practice Address - Country:US
Practice Address - Phone:303-696-6979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COD002051821223G0001X
CODEN.002051821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1497370209Medicaid