Provider Demographics
NPI:1730283888
Name:VAN TUYL, DAVID SEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SEAN
Last Name:VAN TUYL
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:P.O. BOX 2301-285
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498
Mailing Address - Country:US
Mailing Address - Phone:706-669-6969
Mailing Address - Fax:970-262-3866
Practice Address - Street 1:354 BLUE RIVER PKWY
Practice Address - Street 2:UNIT A
Practice Address - City:SILVERTHORNE
Practice Address - State:CO
Practice Address - Zip Code:80498
Practice Address - Country:US
Practice Address - Phone:970-262-2273
Practice Address - Fax:970-262-3866
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002053951223G0001X
GADN013002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000218470Medicaid
GA841686753AMedicaid
GA841686753CMedicaid