Provider Demographics
NPI:1336162825
Name:TRUJILLO, DAVID NATHANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NATHANIEL
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 1:317 W 3RD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1401
Mailing Address - Country:US
Mailing Address - Phone:719-384-8703
Mailing Address - Fax:719-384-2398
Practice Address - Street 1:317 W 3RD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1401
Practice Address - Country:US
Practice Address - Phone:719-384-8703
Practice Address - Fax:719-384-2398
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02005841Medicaid