Provider Demographics
NPI:1124247309
Name:ROY, DAVID ELLIOT (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ELLIOT
Last Name:ROY
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 1:398 N LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2843
Mailing Address - Country:US
Mailing Address - Phone:337-364-5448
Mailing Address - Fax:337-364-5449
Practice Address - Street 1:398 N LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2843
Practice Address - Country:US
Practice Address - Phone:337-364-5448
Practice Address - Fax:337-364-5449
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA21571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics