Healthcare Provider Details

I. General information

NPI: 1285648527
Provider Name (Legal Business Name): TROY NEIL ELMS DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 EMERALD PKWY
COLLEGE STATION TX
77845-5551
US

IV. Provider business mailing address

1501 EMERALD PKWY
COLLEGE STATION TX
77845-5551
US

V. Phone/Fax

Practice location:
  • Phone: 979-693-6300
  • Fax: 979-695-9815
Mailing address:
  • Phone: 979-693-6300
  • Fax: 979-695-9815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number16048
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: