Provider Demographics
NPI:1033324660
Name:STREETE, ROY WINSTON (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:WINSTON
Last Name:STREETE
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 E 230TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4103
Mailing Address - Country:US
Mailing Address - Phone:718-652-3978
Mailing Address - Fax:718-654-9508
Practice Address - Street 1:739 E 230TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4103
Practice Address - Country:US
Practice Address - Phone:718-652-3978
Practice Address - Fax:718-654-9508
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist