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General NPI Number Information
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NPI Number | 1316248966
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Entity Type | Organization
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Legal Business Name | MARK L. TRULSSON, DMD, P.C.
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Dates
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Enumeration Date | 11/14/2010
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Last Update Date | 11/30/2012
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Provider Practice Location Address
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Address Line | 1409 N BELT HWY
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2415
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Country | US
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Telephone | 816-279-0600
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Fax | 816-279-0602
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Provider Business Mailing Address
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Address Line | 1409 N BELT HWY
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2415
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Country | US
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Telephone | 816-279-0600
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Fax | 816-279-0602
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Authorized Official
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Title or Position | OWNER
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Name | MARK L TRULSSON
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Credential | DMD
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Telephone | 816-279-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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