Provider Demographics
NPI:1467447706
Name:TRUJILLO, EDMUND L (DDS)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:L
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 1:4730 BECKNER ROAD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507
Mailing Address - Country:US
Mailing Address - Phone:505-989-4500
Mailing Address - Fax:505-443-8313
Practice Address - Street 1:4730 BECKNER ROAD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507
Practice Address - Country:US
Practice Address - Phone:505-989-4500
Practice Address - Fax:505-443-8313
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD12621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice