Provider Demographics
NPI:1952324527
Name:KREGER, THOMAS MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:KREGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406B SE 131ST AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4004
Mailing Address - Country:US
Mailing Address - Phone:360-892-9184
Mailing Address - Fax:360-892-9406
Practice Address - Street 1:406B SE 131ST AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4004
Practice Address - Country:US
Practice Address - Phone:360-892-9184
Practice Address - Fax:360-892-9406
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA52791223S0112X
ORD60261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA180320764OtherCENTRAL CONTRACTOR REGIST
WA5922OtherWASHINGTON DENTAL SERVICE
WA024238OtherUNITED CONCORDIA