Provider Demographics
NPI:1245289974
Name:TREBUS, DANIEL LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEE
Last Name:TREBUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2817 REILLY ROAD MCDS-NA-B
Mailing Address - Street 2:DEPARTMENT OF THE ARMY DENTAL ACTIVITY STOP B
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7302
Mailing Address - Country:US
Mailing Address - Phone:910-396-5610
Mailing Address - Fax:
Practice Address - Street 1:2817 REILLY ROAD MCDS-NA-B
Practice Address - Street 2:DEPARTMENT OF THE ARMY DENTAL ACTIVITY STOP B
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7302
Practice Address - Country:US
Practice Address - Phone:910-396-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190243641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery