MEDICARE: DR. CARL TRUBSCHENCK D.D.S.

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	122300000X	Dentist	34786	CA

General Provider Information

NPI Number	:	1699966911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL TRUBSCHENCK D.D.S.

Provider Business Mailing Address
First Line	:	8035 MADISON AVE STE E2
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7949
Country	:	US
Telephone Number	:	916-961-1610
Fax Number	:	916-961-1650

Provider Business Practice Location Address
First Line	:	8035 MADISON AVE STE E2
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7949
Country	:	US
Telephone Number	:	916-961-1610
Fax Number	:	916-961-1650

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

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	08/05/2007

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