Healthcare Provider Details

I. General information

NPI: 1710450424
Provider Name (Legal Business Name): GILBERT A. TRUJILLO, DDS APC/KELLIE J. MCGINLEY, DDS, PC-LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 HAMMILL LANE
RENO NV
89511-1004
US

IV. Provider business mailing address

517 HAMMILL LANE
RENO NV
89511-1004
US

V. Phone/Fax

Practice location:
  • Phone: 775-824-2323
  • Fax: 775-824-2324
Mailing address:
  • Phone: 775-824-2323
  • Fax: 775-824-2324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. GILBERT A. TRUJILLO
Title or Position: OWNER/PARTNER
Credential: D.D.S.
Phone: 775-824-2323