Provider Demographics
NPI:1174570527
Name:TREDWAY, MICHEAL EUGENE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:EUGENE
Last Name:TREDWAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27111 EAST LANA LANE
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385
Mailing Address - Country:US
Mailing Address - Phone:281-367-4143
Mailing Address - Fax:
Practice Address - Street 1:17222 RED OAK DR
Practice Address - Street 2:SUITE 105
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2674
Practice Address - Country:US
Practice Address - Phone:281-440-3113
Practice Address - Fax:281-440-9307
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice