Provider Demographics
NPI:1710311386
Name:DAVID R TROST DDS PC
Entity Type:Organization
Organization Name:DAVID R TROST DDS PC
Other - Org Name:MILES OF SMILES, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:TROST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:309-382-6404
Mailing Address - Street 1:137 RADIO CITY DR
Mailing Address - Street 2:STE C
Mailing Address - City:NORTH PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-1570
Mailing Address - Country:US
Mailing Address - Phone:309-382-6404
Mailing Address - Fax:309-382-6405
Practice Address - Street 1:2604 LINCOLN TRL
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-9718
Practice Address - Country:US
Practice Address - Phone:039-382-6404
Practice Address - Fax:309-382-6405
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID R TROST DDS PC D/B/A MILES OF SMILES, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0166071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty