Provider Demographics
NPI:1679133276
Name:TREYZ, CARL
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:TREYZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12963 WALSINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3538
Mailing Address - Country:US
Mailing Address - Phone:727-265-3307
Mailing Address - Fax:727-233-4977
Practice Address - Street 1:12963 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3538
Practice Address - Country:US
Practice Address - Phone:727-265-3307
Practice Address - Fax:727-233-4977
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN243181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice