Provider Demographics
NPI:1952455743
Name:TROYER, STEPHEN HERBERT (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:HERBERT
Last Name:TROYER
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1614
Mailing Address - Country:US
Mailing Address - Phone:812-425-5194
Mailing Address - Fax:812-435-8755
Practice Address - Street 1:550 W VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1614
Practice Address - Country:US
Practice Address - Phone:812-425-5194
Practice Address - Fax:812-435-8755
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120065381223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100246120Medicaid
IN847830AMedicare ID - Type Unspecified
IN100246120Medicaid