Provider Demographics
NPI:1336238955
Name:TREDWAY, MONTE RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:MONTE
Middle Name:RICHARD
Last Name:TREDWAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 VILLAGE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6977
Mailing Address - Country:US
Mailing Address - Phone:850-478-7201
Mailing Address - Fax:850-478-7205
Practice Address - Street 1:6150 VILLAGE OAKS DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6977
Practice Address - Country:US
Practice Address - Phone:850-478-7201
Practice Address - Fax:850-478-7205
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice