Provider Demographics
NPI:1548437072
Name:MADDOX, ROY GUEST (DDS)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:GUEST
Last Name:MADDOX
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 1:13000 SOUTH MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008
Mailing Address - Country:US
Mailing Address - Phone:918-369-1202
Mailing Address - Fax:
Practice Address - Street 1:13000 SOUTH MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008
Practice Address - Country:US
Practice Address - Phone:918-369-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK44171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice