Provider Demographics
NPI:1467591594
Name:BLAND TREGRE, SHAWNA D (DDS)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:D
Last Name:BLAND TREGRE
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 1:6415 FAIRMONT PARKWAY STE A
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505
Mailing Address - Country:US
Mailing Address - Phone:281-998-0022
Mailing Address - Fax:281-998-3016
Practice Address - Street 1:6415 FAIRMONT PARKWAY STE A
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505
Practice Address - Country:US
Practice Address - Phone:281-998-0022
Practice Address - Fax:281-998-3016
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist