Provider Demographics
NPI:1346313566
Name:BROWN TRUNCALE, MARTHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:BROWN TRUNCALE
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 1:116 OCEAN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2216
Mailing Address - Country:US
Mailing Address - Phone:860-536-1765
Mailing Address - Fax:860-536-9542
Practice Address - Street 1:116 OCEAN VIEW AVE
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-2216
Practice Address - Country:US
Practice Address - Phone:860-536-1765
Practice Address - Fax:860-536-9542
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0092361223G0001X
RIDEN029111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice