Provider Demographics
NPI:1679615041
Name:TRUNNELL, HOWARD MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MARK
Last Name:TRUNNELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-6500
Mailing Address - Country:US
Mailing Address - Phone:319-266-7559
Mailing Address - Fax:319-277-5140
Practice Address - Street 1:3722 CEDAR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-6207
Practice Address - Country:US
Practice Address - Phone:319-266-7559
Practice Address - Fax:319-277-5140
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA062081223G0001X
IA62081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0143206Medicaid
IA1679615041Medicaid