Provider Demographics
NPI:1285636928
Name:GEORGE, ROY ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:ALAN
Last Name:GEORGE
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 1:5830 SHOREVIEW LN N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3866
Mailing Address - Country:US
Mailing Address - Phone:503-390-4117
Mailing Address - Fax:
Practice Address - Street 1:5830 SHOREVIEW LN N
Practice Address - Street 2:SUITE 1
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-3866
Practice Address - Country:US
Practice Address - Phone:503-390-4117
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD67231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice