Provider Demographics
NPI:1811219686
Name:TRUJILLO, RAYMOND R (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:R
Last Name:TRUJILLO
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 1:201 BROOKSIDE AVE UNIT 562
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-2523
Mailing Address - Country:US
Mailing Address - Phone:909-965-2200
Mailing Address - Fax:
Practice Address - Street 1:201 BROOKSIDE AVE UNIT 562
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-2523
Practice Address - Country:US
Practice Address - Phone:909-965-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28102122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist