Active NPI
Tate Austin Trujillo, DDS
- Pediatric Dentistry
- Syracuse, UT
National Provider Identifier
1255891511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 12210717-9924
- Practice address
- 780 S 2000 W Ste F2
Syracuse, UT 84075-9609 - Phone
- (801) 217-3359
- NPI assigned
- Mar 22, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 12210717-9924 | UT | Primary |
Addresses
Primary practice location
780 S 2000 W Ste F2
Syracuse, UT 84075-9609
Mailing address
1370 S 4300 W
Syracuse, UT 84075-7159
Phone (801) 707-5937
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12210717-9924 | UT | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553212800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631577600000",
"number": "1255891511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1370 S 4300 W",
"city": "SYRACUSE",
"state": "UT",
"postal_code": "840757159",
"telephone_number": "801-707-5937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "780 S 2000 W STE F2",
"city": "SYRACUSE",
"state": "UT",
"postal_code": "840759609",
"telephone_number": "801-217-3359"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRUJILLO",
"first_name": "TATE",
"middle_name": "AUSTIN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-03-22",
"last_updated": "2021-09-14",
"certification_date": "2021-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "UT",
"license": "12210717-9924",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.