Provider Demographics
NPI:1023208501
Name:BRUCHAL, TRINA MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRINA
Middle Name:MARIE
Last Name:BRUCHAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12900 NE 180TH ST STE 215
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5773
Mailing Address - Country:US
Mailing Address - Phone:425-939-8428
Mailing Address - Fax:425-939-8418
Practice Address - Street 1:12900 NE 180TH ST STE 215
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5773
Practice Address - Country:US
Practice Address - Phone:425-939-8428
Practice Address - Fax:425-939-8418
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000108861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1023208501Medicaid