Provider Demographics
NPI:1003602186
Name:ROYCE, MALINDA GRACE (RDH)
Entity type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:GRACE
Last Name:ROYCE
Suffix:
Gender:
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 LITTLESBURG RD
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-6685
Mailing Address - Country:US
Mailing Address - Phone:304-320-3050
Mailing Address - Fax:
Practice Address - Street 1:5883 BLACK DIAMOND HWY
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:WV
Practice Address - Zip Code:24836
Practice Address - Country:US
Practice Address - Phone:304-448-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2439124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist