Provider Demographics
NPI:1770531998
Name:MARTIN, TROY HAROLD (DMD)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:HAROLD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SPARKS AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3739
Mailing Address - Country:US
Mailing Address - Phone:812-282-8467
Mailing Address - Fax:812-282-3067
Practice Address - Street 1:207 SPARKS AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3739
Practice Address - Country:US
Practice Address - Phone:812-282-8467
Practice Address - Fax:812-282-3067
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120060601223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000226448OtherBLUECROSSBLUESHIELD
IN61-0702891-002OtherTID
IN120970Medicare ID - Type Unspecified