Provider Demographics
NPI:1255891511
Name:TRUJILLO, TATE AUSTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:TATE
Middle Name:AUSTIN
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 1:1370 S 4300 W
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-7159
Mailing Address - Country:US
Mailing Address - Phone:801-707-5937
Mailing Address - Fax:
Practice Address - Street 1:780 S 2000 W STE F2
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-9609
Practice Address - Country:US
Practice Address - Phone:801-217-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12210717-99241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry