Provider Demographics
NPI:1336548361
Name:TRUVAN, TONY (DDS)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:TRUVAN
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 1:3223 DUKE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4586
Mailing Address - Country:US
Mailing Address - Phone:571-257-6994
Mailing Address - Fax:571-357-1044
Practice Address - Street 1:3223 DUKE ST
Practice Address - Street 2:SUITE C
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4586
Practice Address - Country:US
Practice Address - Phone:571-257-6994
Practice Address - Fax:571-357-1044
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist