Provider Demographics
NPI:1093965709
Name:ROYLANCE, TYE A (DDS)
Entity Type:Individual
Prefix:
First Name:TYE
Middle Name:A
Last Name:ROYLANCE
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 1:9652 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2160
Mailing Address - Country:US
Mailing Address - Phone:303-252-4050
Mailing Address - Fax:303-252-4052
Practice Address - Street 1:9652 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2160
Practice Address - Country:US
Practice Address - Phone:303-252-4050
Practice Address - Fax:909-558-4192
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA577381223X0400X
CO103041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10304Medicaid
CA57738OtherSTATE LICENSE