Healthcare Provider Details

I. General information

NPI: 1124024211
Provider Name (Legal Business Name): ROBERTO LUIS TRIGO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 MED PARK DR
LAS CRUCES NM
88005-1131
US

IV. Provider business mailing address

2800 TERESITA ST
LAS CRUCES NM
88005-3893
US

V. Phone/Fax

Practice location:
  • Phone: 505-521-7017
  • Fax: 505-541-0624
Mailing address:
  • Phone: 505-526-3681
  • Fax: 505-541-0624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberNM1775
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: