Provider Demographics
NPI:1891925491
Name:TREGEAGLE, THADDEUS R (DDS)
Entity Type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:R
Last Name:TREGEAGLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:THAD
Other - Middle Name:R
Other - Last Name:TREGEAGLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:9135 SCHAEFER RD
Mailing Address - Street 2:3
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-1979
Mailing Address - Country:US
Mailing Address - Phone:210-607-8232
Mailing Address - Fax:210-368-2132
Practice Address - Street 1:9135 SCHAEFER RD
Practice Address - Street 2:3
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109
Practice Address - Country:US
Practice Address - Phone:210-607-8232
Practice Address - Fax:210-368-2132
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist