Provider Demographics
NPI:1215072483
Name:ROY, DOUGLAS H (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:H
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 1:102 VINE ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-3931
Mailing Address - Country:US
Mailing Address - Phone:304-487-3115
Mailing Address - Fax:304-487-3120
Practice Address - Street 1:102 VINE ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3931
Practice Address - Country:US
Practice Address - Phone:304-487-3115
Practice Address - Fax:304-487-3120
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0316433000Medicaid