Provider Demographics
NPI:1700996147
Name:TROILO, MARK P (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:TROILO
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 98
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:KS
Mailing Address - Zip Code:67133
Mailing Address - Country:US
Mailing Address - Phone:316-776-2144
Mailing Address - Fax:316-776-2980
Practice Address - Street 1:106 E YEAGER
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:KS
Practice Address - Zip Code:67133
Practice Address - Country:US
Practice Address - Phone:316-776-2144
Practice Address - Fax:316-776-2980
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5474122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100097590BOtherHEALTHWAVE
KS17359OtherBLUE CROSS BLUE SHIELD