Provider Demographics
NPI:1144754334
Name:TRUBSCHENCK, DEAN CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:CARL
Last Name:TRUBSCHENCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9740 SHIELDS AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-3834
Mailing Address - Country:US
Mailing Address - Phone:916-860-9323
Mailing Address - Fax:
Practice Address - Street 1:121 SANDY BOTTOM RD
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-5865
Practice Address - Country:US
Practice Address - Phone:401-822-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN03405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist