MEDICARE: DEBORAH ROYSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	14080	FL

General Provider Information

NPI Number	:	1972664779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH ROYSE

Provider Business Mailing Address
First Line	:	1770 N WICKHAM RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-8122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-1140
Country	:	US
Telephone Number	:	813-886-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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Directions to “ DEBORAH ROYSE ” Practice Location

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