MEDICARE: DR. RACHEL LEIGH TRUDELL D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8480	CT

General Provider Information

NPI Number	:	1093727836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL LEIGH TRUDELL D.M.D.

Provider Business Mailing Address
First Line	:	1132 NEW BRITAIN AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-2413
Country	:	US
Telephone Number	:	860-236-6928
Fax Number	:	860-236-6920

Provider Business Practice Location Address
First Line	:	1132 NEW BRITAIN AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-2413
Country	:	US
Telephone Number	:	860-236-6928
Fax Number	:	860-236-6920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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