MEDICARE: DR. CHARLES C TRUNCALE D.M.D.

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	1223D0001X	Public Health Dentistry	008826	CT

General Provider Information

NPI Number	:	1548236045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES C TRUNCALE D.M.D.

Provider Business Mailing Address
First Line	:	USCG HQ, COMDT (CG-1122)
Second Line	:	2100 2ND STREET, RM 5314
City	:	WASHINGTON
State	:	DC
Zip	:	20593-0001
Country	:	US
Telephone Number	:	860-444-8402
Fax Number	:

Provider Business Practice Location Address
First Line	:	USCG ACADEMY, MICHEL HALL
Second Line	:	15 MOHEGAN AVENUE
City	:	NEW LONDON
State	:	CT
Zip	:	06030-3906
Country	:	US
Telephone Number	:	860-444-8402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	07/08/2007

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