Provider Demographics
NPI:1619686813
Name:TUGGLE, DYLAN JAY
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:JAY
Last Name:TUGGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 S JOPLIN CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2537
Mailing Address - Country:US
Mailing Address - Phone:303-483-8505
Mailing Address - Fax:
Practice Address - Street 1:3998 S JOPLIN CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-2537
Practice Address - Country:US
Practice Address - Phone:303-483-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician