MEDICARE: DR. ARIEL E. TRUJILLO D.M.D

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	1223P0300X	Periodontics	6014	AZ

General Provider Information

NPI Number	:	1992913594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARIEL E. TRUJILLO D.M.D

Provider Business Mailing Address
First Line	:	1717 W NORTHERN AVE
Second Line	:	STE #104
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5469
Country	:	US
Telephone Number	:	602-995-5045
Fax Number	:	602-995-3222

Provider Business Practice Location Address
First Line	:	1717 W NORTHERN AVE
Second Line	:	STE #104
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5469
Country	:	US
Telephone Number	:	602-995-5045
Fax Number	:	602-995-3222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	02/22/2013

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