Provider Demographics
NPI:1275624777
Name:TREDWELL, MAUREEN ANN (DDS)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANN
Last Name:TREDWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 WANTAGH AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3936
Mailing Address - Country:US
Mailing Address - Phone:516-785-7529
Mailing Address - Fax:516-785-3229
Practice Address - Street 1:1599 WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3936
Practice Address - Country:US
Practice Address - Phone:516-785-7529
Practice Address - Fax:516-785-3229
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042072-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice