MEDICARE: DR. DANIELLE C TRUDEAU DDS

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	8753	CT

General Provider Information

NPI Number	:	1972542397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE C TRUDEAU DDS

Provider Business Mailing Address
First Line	:	727 NORWICH NEW LONDON TPKE
Second Line	:
City	:	UNCASVILLE
State	:	CT
Zip	:	06382-2123
Country	:	US
Telephone Number	:	860-848-0662
Fax Number	:	860-848-0662

Provider Business Practice Location Address
First Line	:	88 NORWICH NEW LONDON TPKE STE 1
Second Line	:
City	:	UNCASVILLE
State	:	CT
Zip	:	06382-2518
Country	:	US
Telephone Number	:	860-848-0662
Fax Number	:	860-848-0662

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	04/20/2022

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