Provider Demographics
NPI:1750825394
Name:JD TROY DDS PLLC
Entity Type:Organization
Organization Name:JD TROY DDS PLLC
Other - Org Name:TROY FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JD
Authorized Official - Middle Name:
Authorized Official - Last Name:TROY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-423-5240
Mailing Address - Street 1:1118 OCEAN BEACH HWY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4638
Mailing Address - Country:US
Mailing Address - Phone:360-423-5240
Mailing Address - Fax:360-501-5391
Practice Address - Street 1:1118 OCEAN BEACH HWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4638
Practice Address - Country:US
Practice Address - Phone:360-423-5240
Practice Address - Fax:360-501-5391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008468261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental