Provider Demographics
NPI:1548402589
Name:TRULOVE & PETRUNICE ORTHODONTICS
Entity Type:Organization
Organization Name:TRULOVE & PETRUNICE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:TRULOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:334-277-2980
Mailing Address - Street 1:4164 CARMICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3600
Mailing Address - Country:US
Mailing Address - Phone:334-277-2980
Mailing Address - Fax:
Practice Address - Street 1:4164 CARMICHAEL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3600
Practice Address - Country:US
Practice Address - Phone:334-277-2980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty