Healthcare Provider Details

I. General information

NPI: 1639138084
Provider Name (Legal Business Name): ROGER RYAN ROYBAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 E SOUTHERN AVE STE 23
TEMPE AZ
85282-7669
US

IV. Provider business mailing address

5601 W EUGIE AVE STE 206
GLENDALE AZ
85304-1258
US

V. Phone/Fax

Practice location:
  • Phone: 623-299-8799
  • Fax: 623-299-8800
Mailing address:
  • Phone: 623-299-8799
  • Fax: 623-299-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4956
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: