Provider Demographics
NPI:1548239700
Name:TRUESDALE, DANA AUBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:AUBERT
Last Name:TRUESDALE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:THERESA
Other - Last Name:AUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1001 FLEET STREET
Mailing Address - Street 2:UNIT R
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202
Mailing Address - Country:US
Mailing Address - Phone:410-385-9966
Mailing Address - Fax:410-383-1988
Practice Address - Street 1:1001 FLEET ST STE R
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4371
Practice Address - Country:US
Practice Address - Phone:104-385-9966
Practice Address - Fax:410-383-1988
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15061122300000X, 1223G0001X
VA04014110001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9180526Medicaid
VA9180526Medicaid