Provider Demographics
NPI:1518387828
Name:TROYER, MITCHELL IAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:IAN
Last Name:TROYER
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 1:1600 S ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2510
Mailing Address - Country:US
Mailing Address - Phone:954-355-5703
Mailing Address - Fax:
Practice Address - Street 1:550 W VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1684
Practice Address - Country:US
Practice Address - Phone:812-425-5194
Practice Address - Fax:812-858-3110
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012163A1223S0112X
FLDRPM1461390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery