MEDICARE: TRULOVE ORTHODONTICS, P.C.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	4204	AL

General Provider Information

NPI Number	:	1336559855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRULOVE ORTHODONTICS, P.C.

Provider Business Mailing Address
First Line	:	4164 CARMICHAEL RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-3600
Country	:	US
Telephone Number	:	334-277-2980
Fax Number	:	334-277-2987

Provider Business Practice Location Address
First Line	:	4164 CARMICHAEL RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-3600
Country	:	US
Telephone Number	:	334-277-2980
Fax Number	:	334-277-2987

Authorized Official
Title or Position	:	BOOK KEEPER
Name	:	MRS. ANITA HARRIS
Credential	:
Telephone Number	:	334-277-2980

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	05/06/2014

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