Provider Demographics
NPI:1285847061
Name:HOLDER, TROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:
Last Name:HOLDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 N WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-1548
Mailing Address - Country:US
Mailing Address - Phone:260-665-7517
Mailing Address - Fax:260-665-7517
Practice Address - Street 1:224 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1548
Practice Address - Country:US
Practice Address - Phone:765-742-3100
Practice Address - Fax:765-742-0152
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120102641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200286270Medicaid