Provider Demographics
NPI:1033212196
Name:ROYBAL, MARIO JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:JOSEPH
Last Name:ROYBAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 POPPS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2120
Mailing Address - Country:US
Mailing Address - Phone:228-388-4519
Mailing Address - Fax:228-388-8757
Practice Address - Street 1:1867 POPPS FERRY RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2120
Practice Address - Country:US
Practice Address - Phone:228-388-4519
Practice Address - Fax:228-388-8757
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1791-771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice