MEDICARE: TRUMBULL ORTHODONICS

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	009201	CT

General Provider Information

NPI Number	:	1144653403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUMBULL ORTHODONICS

Provider Business Mailing Address
First Line	:	126 MONROE TPKE
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-1300
Country	:	US
Telephone Number	:	860-670-1905
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 MONROE TPKE
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-1300
Country	:	US
Telephone Number	:	860-670-1905
Fax Number	:

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. LUBNA KHAN
Credential	:	D.M.D, M.D.S
Telephone Number	:	860-670-1905

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	08/09/2013

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Directions to “TRUMBULL ORTHODONICS ” Practice Location

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