Healthcare Provider Details

I. General information

NPI: 1831249648
Provider Name (Legal Business Name): JOHN E ROYAL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 BEECHLAND RD. BOX 518
ELLSWORTH ME
04605
US

IV. Provider business mailing address

97 BEECHLAND ROAD P.O. BOX 518
ELLSWORTH ME
04605
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-0500
  • Fax: 207-667-7610
Mailing address:
  • Phone: 207-667-0500
  • Fax: 207-667-7610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2639
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: