MEDICARE: DR. TAMMY MARIE TRULLARD 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	1223G0001X	General Practice Dentistry	2901014156	MI

General Provider Information

NPI Number	:	1710020680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMMY MARIE TRULLARD D.D.S.

Provider Business Mailing Address
First Line	:	2340 E STADIUM BLVD
Second Line	:	SUITE 7
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-4823
Country	:	US
Telephone Number	:	734-973-0000
Fax Number	:	734-973-9650

Provider Business Practice Location Address
First Line	:	2340 E STADIUM BLVD
Second Line	:	SUITE 7
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-4823
Country	:	US
Telephone Number	:	734-973-0000
Fax Number	:	734-973-9650

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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