Healthcare Provider Details

I. General information

NPI: 1548402589
Provider Name (Legal Business Name): TRULOVE & PETRUNICE ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4164 CARMICHAEL RD
MONTGOMERY AL
36106-3600
US

IV. Provider business mailing address

4164 CARMICHAEL RD
MONTGOMERY AL
36106-3600
US

V. Phone/Fax

Practice location:
  • Phone: 334-277-2980
  • Fax:
Mailing address:
  • Phone: 334-277-2980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4204
License Number StateAL

VIII. Authorized Official

Name: DR. TIM S. TRULOVE
Title or Position: DR.
Credential: D.M.D, M.D
Phone: 334-277-2980