MEDICARE: COREY TRUMAN, DMD, PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1184370355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COREY TRUMAN, DMD, PLLC

Provider Business Mailing Address
First Line	:	113 WIND WOOD DR
Second Line	:
City	:	PORTLAND
State	:	TN
Zip	:	37148-2063
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 WIND WOOD DR
Second Line	:
City	:	PORTLAND
State	:	TN
Zip	:	37148-2063
Country	:	US
Telephone Number	:	502-681-4513
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. COREY TRUMAN
Credential	:	DMD
Telephone Number	:	502-681-4513

Provider Enumeration Date	:	02/26/2022
Last Update Date	:	02/26/2022

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