Provider Demographics
NPI:1730230863
Name:ROY, GREGG J (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:J
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 1:120 APPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:LA
Mailing Address - Zip Code:70079-2216
Mailing Address - Country:US
Mailing Address - Phone:985-764-7066
Mailing Address - Fax:
Practice Address - Street 1:120 APPLE ST
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:LA
Practice Address - Zip Code:70079-2216
Practice Address - Country:US
Practice Address - Phone:985-764-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA45831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice