Organization Name: | TRINA BRUCHAL, DMD, PLLC |
NPI Number: | 1033411053 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TRINA MARIE BRUCHAL (OWNER/ORTHODONTIST) |
Mailing Address: | 12900 Ne 180th St Ste 215 Bothell |
State: | WA US |
Postal Code: | 980115773 |
Phone Number: | 4259398428 |
Fax Number: | 4259398418 |
NPI Enumeration Date: | 11/23/2010 |
NPI Last Update Date: | 12/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | DE00010886 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |