Provider Demographics
NPI:1730277781
Name:KEYES, TROY
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:KEYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 N DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-6419
Mailing Address - Country:US
Mailing Address - Phone:605-367-8022
Mailing Address - Fax:605-367-8001
Practice Address - Street 1:132 N DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-6419
Practice Address - Country:US
Practice Address - Phone:605-367-8022
Practice Address - Fax:605-367-8001
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM9531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5350010Medicaid