Provider Demographics
NPI:1659459279
Name:TROTT, BRUCE LLYOD (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LLYOD
Last Name:TROTT
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 295
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:10505-0295
Mailing Address - Country:US
Mailing Address - Phone:845-628-5518
Mailing Address - Fax:845-628-5519
Practice Address - Street 1:17 MILLER RD
Practice Address - Street 2:
Practice Address - City:BALDWIN PLACE
Practice Address - State:NY
Practice Address - Zip Code:10505
Practice Address - Country:US
Practice Address - Phone:845-628-5518
Practice Address - Fax:845-628-5519
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00509664Medicaid
NY132876891OtherTAX ID NUMBER