Provider Demographics
NPI:1851757512
Name:ALEXANDER D TRUJILLO DDS PA
Entity Type:Organization
Organization Name:ALEXANDER D TRUJILLO DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-235-9321
Mailing Address - Street 1:8441 SW 132ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-6505
Mailing Address - Country:US
Mailing Address - Phone:305-235-9321
Mailing Address - Fax:305-772-6258
Practice Address - Street 1:8441 SW 132ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-6505
Practice Address - Country:US
Practice Address - Phone:305-235-9321
Practice Address - Fax:305-772-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN168621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty