Provider Demographics
NPI:1831944164
Name:TROOPER DENTAL ASSOCIATES PC
Entity type:Organization
Organization Name:TROOPER DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIA C
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-283-3326
Mailing Address - Street 1:182 VALLEY STREAM CIR
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5818
Mailing Address - Country:US
Mailing Address - Phone:305-283-3326
Mailing Address - Fax:
Practice Address - Street 1:2412 RHAWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3324
Practice Address - Country:US
Practice Address - Phone:215-332-5259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty