Provider Demographics
NPI:1912881632
Name:TRUFORM SURGERY, PLLC
Entity type:Organization
Organization Name:TRUFORM SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:KY
Authorized Official - Last Name:EIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FACS
Authorized Official - Phone:517-321-3236
Mailing Address - Street 1:1390 SHADY CREST DR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-3321
Mailing Address - Country:US
Mailing Address - Phone:330-338-3960
Mailing Address - Fax:
Practice Address - Street 1:4124 W ST JOE HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-5205
Practice Address - Country:US
Practice Address - Phone:517-321-3236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty