Provider Demographics
NPI:1154492619
Name:PUGH, ROY EDWARD (DDS,LTD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:EDWARD
Last Name:PUGH
Suffix:
Gender:M
Credentials:DDS,LTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 367
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:VA
Mailing Address - Zip Code:22572-0367
Mailing Address - Country:US
Mailing Address - Phone:804-333-4054
Mailing Address - Fax:804-333-5012
Practice Address - Street 1:5671 RICHMOND ROAD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:VA
Practice Address - Zip Code:22572-0367
Practice Address - Country:US
Practice Address - Phone:804-333-4054
Practice Address - Fax:804-333-5012
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010068881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice