Provider Demographics
NPI:1154692911
Name:BACON, TROY (DDS)
Entity type:Individual
Prefix:DR
First Name:TROY
Middle Name:
Last Name:BACON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 N. AUDUBON
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208
Mailing Address - Country:US
Mailing Address - Phone:509-290-0960
Mailing Address - Fax:
Practice Address - Street 1:7275 SW DARTMOUTH ST
Practice Address - Street 2:STE 180
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8292
Practice Address - Country:US
Practice Address - Phone:503-620-2319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD102951223X0400X
WADE605768001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics