Provider Demographics
NPI:1033411053
Name:TRINA BRUCHAL, DMD, PLLC
Entity Type:Organization
Organization Name:TRINA BRUCHAL, DMD, PLLC
Other - Org Name:BRUCHAL ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRUCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-939-8428
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010886261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1023208501Medicaid