Provider Demographics
NPI:1851313944
Name:TROUTMAN, GARY WOOD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WOOD
Last Name:TROUTMAN
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:PO BOX 9092
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86313-9092
Mailing Address - Country:US
Mailing Address - Phone:928-445-1372
Mailing Address - Fax:
Practice Address - Street 1:500 N. HWY 89
Practice Address - Street 2:PSC 160
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313-5001
Practice Address - Country:US
Practice Address - Phone:928-776-6177
Practice Address - Fax:928-776-6131
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0133781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice