Provider Demographics
NPI:1407185234
Name:GERMAN A TRUJILLO DDS DENTAL CORPORATION
Entity type:Organization
Organization Name:GERMAN A TRUJILLO DDS DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-204-7722
Mailing Address - Street 1:4520 EXECUTIVE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3020
Mailing Address - Country:US
Mailing Address - Phone:858-434-7554
Mailing Address - Fax:858-597-1005
Practice Address - Street 1:4520 EXECUTIVE DR STE 220
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3020
Practice Address - Country:US
Practice Address - Phone:858-434-7554
Practice Address - Fax:858-597-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570081223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty