Provider Demographics
NPI:1972952653
Name:TERRY M. TREZEK DENTAL GROUP
Entity Type:Organization
Organization Name:TERRY M. TREZEK DENTAL GROUP
Other - Org Name:TERRY M. TREZEK GROUP, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TREZEK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:636-462-8599
Mailing Address - Street 1:395 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-1405
Mailing Address - Country:US
Mailing Address - Phone:636-462-8599
Mailing Address - Fax:636-528-8598
Practice Address - Street 1:395 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-1405
Practice Address - Country:US
Practice Address - Phone:636-462-8599
Practice Address - Fax:636-528-8598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001615661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty