Healthcare Provider Details

I. General information

NPI: 1326349556
Provider Name (Legal Business Name): BRUCE R. TREFZ, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 X RAY DR
GASTONIA NC
28054-7489
US

IV. Provider business mailing address

1041 X RAY DR
GASTONIA NC
28054-7489
US

V. Phone/Fax

Practice location:
  • Phone: 704-861-1235
  • Fax: 704-853-2510
Mailing address:
  • Phone: 704-861-1235
  • Fax: 704-853-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4960
License Number StateNC

VIII. Authorized Official

Name: DR. BRUCE ROBERT TREFZ
Title or Position: PRESIDENT
Credential:
Phone: 704-861-1235