Provider Demographics
NPI:1619039955
Name:JADE MILLER DDS GILBERT A TRUJILLO DDS
Entity Type:Organization
Organization Name:JADE MILLER DDS GILBERT A TRUJILLO DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JADE
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-824-2323
Mailing Address - Street 1:517 HAMMILL LANE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511
Mailing Address - Country:US
Mailing Address - Phone:775-824-2323
Mailing Address - Fax:775-824-2324
Practice Address - Street 1:517 HAMMILL LANE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:775-824-2323
Practice Address - Fax:775-824-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2216819Medicaid
NV2216801Medicaid