Provider Demographics
NPI:1346370632
Name:ROYSTER, DONALD E (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:E
Last Name:ROYSTER
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:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27239-0428
Mailing Address - Country:US
Mailing Address - Phone:336-859-4435
Mailing Address - Fax:336-859-5682
Practice Address - Street 1:179 W SALISBURY ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:NC
Practice Address - Zip Code:27239-6926
Practice Address - Country:US
Practice Address - Phone:336-859-4435
Practice Address - Fax:336-859-5682
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997516Medicaid