Healthcare Provider Details

I. General information

NPI: 1063557007
Provider Name (Legal Business Name): TRU DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3849 FOOTHILLS RD SUITE A
LAS CRUCES NM
88011
US

IV. Provider business mailing address

3849 FOOTHILLS RD SUITE A
LAS CRUCES NM
88011
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-0888
  • Fax: 575-526-9775
Mailing address:
  • Phone: 575-526-0888
  • Fax: 575-526-9775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2171
License Number StateNM

VIII. Authorized Official

Name: RENEE TRUJILLO
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 505-526-0888