Provider Demographics
NPI:1134299712
Name:STRUPP, TREVOR R (DMD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:R
Last Name:STRUPP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-3758
Mailing Address - Country:US
Mailing Address - Phone:406-222-7197
Mailing Address - Fax:
Practice Address - Street 1:1313 W PARK ST STE 2
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2900
Practice Address - Country:US
Practice Address - Phone:406-222-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4035122300000X
MT2344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist