Provider Demographics
NPI:1457521957
Name:NAZARIO N. YOUNG-TRUJILLO, DDS, INC
Entity Type:Organization
Organization Name:NAZARIO N. YOUNG-TRUJILLO, DDS, INC
Other - Org Name:HIGH COUNTRY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAZARIO
Authorized Official - Middle Name:N
Authorized Official - Last Name:YOUNG-TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-323-7700
Mailing Address - Street 1:10820 COMANCHE RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10820 COMANCHE RD NE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3983
Practice Address - Country:US
Practice Address - Phone:505-323-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADD27541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty