Provider Demographics
NPI:1174522767
Name:TREASURE, TREVOR (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:
Last Name:TREASURE
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12436 BREAKLINES ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12436 BREAKLINES ST
Practice Address - Street 2:SUITE 408
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7678
Practice Address - Country:US
Practice Address - Phone:317-625-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010719A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery