MEDICARE: DR. AMBER THERESE ROYAL DDS

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	122300000X	Dentist	60745	KS
2	122300000X	Dentist	15119	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437468576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMBER THERESE ROYAL DDS

Provider Business Mailing Address
First Line	:	6618A SECURITY BLVD
Second Line	:
City	:	WOODLAWN
State	:	MD
Zip	:	21207-4010
Country	:	US
Telephone Number	:	410-575-1833
Fax Number	:	410-803-5297

Provider Business Practice Location Address
First Line	:	6618A SECURITY BLVD
Second Line	:
City	:	WOODLAWN
State	:	MD
Zip	:	21207-4010
Country	:	US
Telephone Number	:	410-575-1833
Fax Number	:	410-803-5297

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

Provider Enumeration Date	:	10/06/2010
Last Update Date	:	02/19/2020

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