Provider Demographics
NPI:1720743586
Name:BUEHRIG, TRYSTA (RDH, EPDH, BS)
Entity Type:Individual
Prefix:
First Name:TRYSTA
Middle Name:
Last Name:BUEHRIG
Suffix:
Gender:F
Credentials:RDH, EPDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61394 COACHMAN WAY
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3840
Mailing Address - Country:US
Mailing Address - Phone:541-912-8802
Mailing Address - Fax:
Practice Address - Street 1:61394 COACHMAN WAY
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3840
Practice Address - Country:US
Practice Address - Phone:541-515-7228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6142124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist