Provider Demographics
NPI:1083135768
Name:ROYE, ADAM CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:CHARLES
Last Name:ROYE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OKOLONA
Mailing Address - State:MS
Mailing Address - Zip Code:38860-1427
Mailing Address - Country:US
Mailing Address - Phone:662-447-2704
Mailing Address - Fax:
Practice Address - Street 1:233 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OKOLONA
Practice Address - State:MS
Practice Address - Zip Code:38860-1427
Practice Address - Country:US
Practice Address - Phone:662-447-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3939-17122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03920614Medicaid