Provider Demographics
NPI:1215470422
Name:ROYAL RSVG PLLC
Entity type:Organization
Organization Name:ROYAL RSVG PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-493-1216
Mailing Address - Street 1:10909 WEBB CHAPEL RD
Mailing Address - Street 2:SUITE 159
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-3739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10909 WEBB CHAPEL RD
Practice Address - Street 2:SUITE 159
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-3739
Practice Address - Country:US
Practice Address - Phone:214-493-1216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty