Provider Demographics
NPI:1114946027
Name:WILLIAMS TRUJILLO, AMY (DDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WILLIAMS TRUJILLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 THAMES
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906
Mailing Address - Country:US
Mailing Address - Phone:719-633-1355
Mailing Address - Fax:
Practice Address - Street 1:5426 N ACADEMY BLVD STE 201
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3687
Practice Address - Country:US
Practice Address - Phone:719-528-6441
Practice Address - Fax:719-528-2488
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice