Provider Demographics
NPI:1649364647
Name:TROY, JD (DDS)
Entity type:Individual
Prefix:DR
First Name:JD
Middle Name:
Last Name:TROY
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 1:1516 HUDSON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3083
Mailing Address - Country:US
Mailing Address - Phone:360-423-5240
Mailing Address - Fax:360-501-5391
Practice Address - Street 1:1516 HUDSON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3083
Practice Address - Country:US
Practice Address - Phone:360-423-5240
Practice Address - Fax:360-501-5391
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 000084681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice