Healthcare Provider Details

I. General information

NPI: 1902817166
Provider Name (Legal Business Name): TOM J TROILO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MAIN ST
VALLEY CENTER KS
67147-2217
US

IV. Provider business mailing address

201 W MAIN ST
VALLEY CENTER KS
67147-2217
US

V. Phone/Fax

Practice location:
  • Phone: 316-755-1203
  • Fax: 316-755-1207
Mailing address:
  • Phone: 316-755-1203
  • Fax: 316-755-1207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6395
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: