MEDICARE: ALEXANDER D TRUJILLO DDS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN16862	FL

General Provider Information

NPI Number	:	1851757512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANDER D TRUJILLO DDS PA

Provider Business Mailing Address
First Line	:	8441 SW 132ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-6505
Country	:	US
Telephone Number	:	305-235-9321
Fax Number	:	305-772-6258

Provider Business Practice Location Address
First Line	:	8441 SW 132ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-6505
Country	:	US
Telephone Number	:	305-235-9321
Fax Number	:	305-772-6258

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXANDER D TRUJILLO
Credential	:
Telephone Number	:	305-235-9321

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	01/12/2016

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