Provider Demographics
NPI:1548236045
Name:TRUNCALE, CHARLES C (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:TRUNCALE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USCG HQ, COMDT (CG-1122)
Mailing Address - Street 2:2100 2ND STREET, RM 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:860-444-8402
Mailing Address - Fax:
Practice Address - Street 1:USCG ACADEMY, MICHEL HALL
Practice Address - Street 2:15 MOHEGAN AVENUE
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06030-3906
Practice Address - Country:US
Practice Address - Phone:860-444-8402
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0088261223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health