Organization
SKYLINE DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR ELIAS TRUJILLO DDS (DOCTOR MANAGER)
(520) 579-3393
Entity
Organization
Contact information
Practice address
3918 W INA RD, SUITE D100, TUCSON, AZ 85741-2241
(520) 579-3393
(520) 579-3005
Mailing address
3918 W INA RD, SUITE D100, TUCSON, AZ 85741-2241
(520) 579-3393
(520) 579-3005
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3864
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
882447
UNITED CONCORDIA
—
01
—
AZ0103321
BLUE CROSS BLUE SHIELD OF
AZ
Enumeration date
01/30/2007
Last updated
08/22/2020
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