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General NPI Number Information
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NPI Number | 1700295771
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Entity Type | Organization
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Legal Business Name | SUSAN L ROYER DDS PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 9291 E 109TH AVE
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City | CROWN POINT
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State | IN
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Zip | 46307-8676
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Country | US
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Telephone | 219-663-4024
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Fax |
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Provider Business Mailing Address
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Address Line | 2587 W 65TH AVE
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City | MERRILLVILLE
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State | IN
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Zip | 46410-2833
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Country | US
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Telephone | 219-663-4024
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DR. SUSAN ROYER
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Credential | DDS
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Telephone | 219-663-4024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019022078
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 12009289
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License Number State | IN
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