Provider Demographics
NPI:1003030933
Name:DAVID N. TRUJILLO, DDS, PC
Entity Type:Organization
Organization Name:DAVID N. TRUJILLO, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:N
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-384-8703
Mailing Address - Street 1:317 W 3RD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1401
Mailing Address - Country:US
Mailing Address - Phone:719-384-8703
Mailing Address - Fax:719-384-2398
Practice Address - Street 1:317 W 3RD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1401
Practice Address - Country:US
Practice Address - Phone:719-384-8703
Practice Address - Fax:719-384-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04008603Medicaid