Provider Demographics
NPI:1972256865
Name:ACCESS DENTAL OF TRIVIZ LLC
Entity Type:Organization
Organization Name:ACCESS DENTAL OF TRIVIZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-242-0743
Mailing Address - Street 1:1748 S TRIVIZ DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5103
Mailing Address - Country:US
Mailing Address - Phone:575-522-1983
Mailing Address - Fax:575-522-3435
Practice Address - Street 1:1748 S TRIVIZ DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5103
Practice Address - Country:US
Practice Address - Phone:575-522-1983
Practice Address - Fax:575-522-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty