Provider Demographics
NPI:1073541629
Name:BEDROCK, ROY DENNIS (MS DMD MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:DENNIS
Last Name:BEDROCK
Suffix:
Gender:M
Credentials:MS DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2157
Mailing Address - Country:US
Mailing Address - Phone:727-216-6155
Mailing Address - Fax:727-216-6155
Practice Address - Street 1:1008 WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2157
Practice Address - Country:US
Practice Address - Phone:727-216-6155
Practice Address - Fax:727-216-6155
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL286191223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty