Healthcare Provider Details

I. General information

NPI: 1619708666
Provider Name (Legal Business Name): TRUE DENTAL SMILES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 COPPER PL
FORT LUPTON CO
80621-1601
US

IV. Provider business mailing address

110 COPPER PL
FORT LUPTON CO
80621-1601
US

V. Phone/Fax

Practice location:
  • Phone: 303-990-8550
  • Fax: 303-990-8550
Mailing address:
  • Phone: 303-990-8550
  • Fax: 303-990-8550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TONI TRUJILLO
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 303-990-8550