Provider Demographics
NPI:1508880162
Name:TREZEK, TERRY M (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:M
Last Name:TREZEK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 MARKET CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8407
Mailing Address - Country:US
Mailing Address - Phone:636-329-1254
Mailing Address - Fax:636-329-1837
Practice Address - Street 1:1630 MARKET CENTER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7324
Practice Address - Country:US
Practice Address - Phone:636-329-1254
Practice Address - Fax:636-329-1837
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001615661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice