Provider Demographics
NPI:1164614426
Name:GOZA, ROYCE JACOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROYCE
Middle Name:JACOB
Last Name:GOZA
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 1:135 E HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5719
Mailing Address - Country:US
Mailing Address - Phone:504-615-4352
Mailing Address - Fax:
Practice Address - Street 1:1850 CREST RD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-4305
Practice Address - Country:US
Practice Address - Phone:865-982-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58631223G0001X
TN87341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice