Provider Demographics
NPI:1467614701
Name:STANSBERRY, TROY (DDS)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:STANSBERRY
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 1:7501 N 16TH ST STE 100
Mailing Address - Street 2:STE 110
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4677
Mailing Address - Country:US
Mailing Address - Phone:602-944-9197
Mailing Address - Fax:602-944-9195
Practice Address - Street 1:7501 N. 16TH ST.
Practice Address - Street 2:STE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-944-9197
Practice Address - Fax:602-944-9195
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD74891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice