Provider Demographics
NPI:1073570446
Name:TRESKA, THOMAS PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:PAUL
Last Name:TRESKA
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 1:9439 HAMMONTREE DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1338
Mailing Address - Country:US
Mailing Address - Phone:515-967-4236
Mailing Address - Fax:515-967-3429
Practice Address - Street 1:300 ELM AVE SW
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:IA
Practice Address - Zip Code:50169-7726
Practice Address - Country:US
Practice Address - Phone:515-967-4236
Practice Address - Fax:515-967-3429
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE45851223G0001X
IA67591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice