Provider Demographics
NPI:1588747570
Name:ROY, BRYAN J (DDS, MSD, PC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:J
Last Name:ROY
Suffix:
Gender:M
Credentials:DDS, MSD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 PARKDALE PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-6603
Mailing Address - Country:US
Mailing Address - Phone:317-293-7171
Mailing Address - Fax:317-293-7180
Practice Address - Street 1:6825 PARKDALE PL
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-6603
Practice Address - Country:US
Practice Address - Phone:317-293-7171
Practice Address - Fax:317-293-7180
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120088211223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics