MEDICARE: DR. TROY DANIEL FAIRCLOUGH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30.027144	OH

General Provider Information

NPI Number	:	1801588900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TROY DANIEL FAIRCLOUGH DDS

Provider Business Mailing Address
First Line	:	280 SCIO RD SE
Second Line	:
City	:	CARROLLTON
State	:	OH
Zip	:	44615
Country	:	US
Telephone Number	:	330-312-8196
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 TRUMP RD NW
Second Line	:
City	:	CARROLLTON
State	:	OH
Zip	:	44615-9472
Country	:	US
Telephone Number	:	330-627-5666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2023
Last Update Date	:	05/25/2023

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