=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346471075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMITH & ROY DENTISTRY PARTNERSHIP-DR. JEFF ROY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2009
-----------------------------------------------------
Last Update Date | 07/29/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4301 N MACARTHUR BLVD SUITE 100
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75038-6497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-255-3712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4301 N MACARTHUR BLVD SUITE 100
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75038-6497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-255-3712
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | D.D.S.
-----------------------------------------------------
Name | ROY JEFF
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 972-255-3712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 18758
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------