Provider Demographics
NPI:1477598332
Name:VANOPDORP, TROY R (DMD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:R
Last Name:VANOPDORP
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 1:334 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:DESLOGE
Mailing Address - State:MO
Mailing Address - Zip Code:63601-3052
Mailing Address - Country:US
Mailing Address - Phone:573-431-0020
Mailing Address - Fax:573-431-1022
Practice Address - Street 1:334 N STATE ST
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-3052
Practice Address - Country:US
Practice Address - Phone:573-431-0020
Practice Address - Fax:573-431-1022
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0159331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice