Provider Demographics
NPI:1992913594
Name:TRUJILLO, ARIEL E (DMD)
Entity type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:E
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W NORTHERN AVE
Mailing Address - Street 2:STE #104
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5469
Mailing Address - Country:US
Mailing Address - Phone:602-995-5045
Mailing Address - Fax:602-995-3222
Practice Address - Street 1:1717 W NORTHERN AVE
Practice Address - Street 2:STE #104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5469
Practice Address - Country:US
Practice Address - Phone:602-995-5045
Practice Address - Fax:602-995-3222
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ60141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics