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General NPI Number Information
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NPI Number | 1891925491
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Entity Type | Individual
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Provider Name | THADDEUS R TREGEAGLE DDS
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Gender | Male
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 9135 SCHAEFER RD 3
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City | CONVERSE
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State | TX
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Zip | 78109
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Country | US
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Telephone | 210-607-8232
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Fax | 210-368-2132
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Provider Business Mailing Address
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Address Line | 9135 SCHAEFER RD 3
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City | CONVERSE
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State | TX
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Zip | 78109-1979
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Country | US
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Telephone | 210-607-8232
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Fax | 210-368-2132
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 26566
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License Number State | TX
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