Provider Demographics
NPI:1073695961
Name:YOUNG-TRUJILLO, NAZARIO N (DDS)
Entity type:Individual
Prefix:DR
First Name:NAZARIO
Middle Name:N
Last Name:YOUNG-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 1:4231 TALMADGE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5546
Mailing Address - Country:US
Mailing Address - Phone:505-681-8004
Mailing Address - Fax:
Practice Address - Street 1:312 UNSER BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2472
Practice Address - Country:US
Practice Address - Phone:505-796-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD27541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice