Provider Demographics
NPI:1457664336
Name:ROBECK, TROY DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:DANIEL
Last Name:ROBECK
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 1:395 MAIN STREET LOOP
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7727
Mailing Address - Country:US
Mailing Address - Phone:907-283-7759
Mailing Address - Fax:907-283-4883
Practice Address - Street 1:395 MAIN STREET LOOP
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7727
Practice Address - Country:US
Practice Address - Phone:907-283-7759
Practice Address - Fax:907-283-4883
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK13441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice