Provider Demographics
NPI:1376565192
Name:TRUSKE, JOSEPH THOMAS (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:TRUSKE
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 24TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-4102
Mailing Address - Country:US
Mailing Address - Phone:810-984-1586
Mailing Address - Fax:810-984-4789
Practice Address - Street 1:3901 24TH AVENUE
Practice Address - Street 2:
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-4102
Practice Address - Country:US
Practice Address - Phone:810-984-1586
Practice Address - Fax:810-984-4789
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI088871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA663672OtherUNITED CONCORDIA