Healthcare Provider Details

I. General information

NPI: 1760651475
Provider Name (Legal Business Name): ROBERT E. TRULY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 W. WHITE OAK TERRACE SUITE A
CONROE TX
77304-3590
US

IV. Provider business mailing address

1805 W. WHITE OAK TERRACE SUITE A
CONROE TX
77304-3590
US

V. Phone/Fax

Practice location:
  • Phone: 936-588-4433
  • Fax: 936-588-4603
Mailing address:
  • Phone: 936-588-4433
  • Fax: 936-588-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7156
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: