Healthcare Provider Details

I. General information

NPI: 1639283641
Provider Name (Legal Business Name): TRIGO & TRIGO DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 MED PARK DRIVE
LAS CRUCES NM
88005
US

IV. Provider business mailing address

1131 MED PARK DRIVE
LAS CRUCES NM
88005
US

V. Phone/Fax

Practice location:
  • Phone: 505-521-7017
  • Fax: 505-541-0624
Mailing address:
  • Phone: 505-521-7017
  • Fax: 505-541-0624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1775
License Number StateNM

VIII. Authorized Official

Name: ROBERTO L TRIGO
Title or Position: DENTIST
Credential: DDS
Phone: 505-521-7017