Provider Demographics
NPI:1417166257
Name:H MARK TRUNNELL DDS PC
Entity Type:Organization
Organization Name:H MARK TRUNNELL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:TRUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-352-4488
Mailing Address - Street 1:325 21ST ST NW
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-2019
Mailing Address - Country:US
Mailing Address - Phone:319-352-4488
Mailing Address - Fax:319-352-4489
Practice Address - Street 1:325 21ST ST NW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2019
Practice Address - Country:US
Practice Address - Phone:319-352-4488
Practice Address - Fax:319-352-4489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0143206Medicaid