Provider Demographics
NPI:1265582472
Name:TRYGSTAD, PAUL MARTIN (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MARTIN
Last Name:TRYGSTAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 WATERFRONT DRIVE
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616
Mailing Address - Country:US
Mailing Address - Phone:218-834-2354
Mailing Address - Fax:218-834-2354
Practice Address - Street 1:123 WATERFRONT DRIVE
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616
Practice Address - Country:US
Practice Address - Phone:218-834-2354
Practice Address - Fax:218-834-2354
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9087122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist