Provider Demographics
NPI:1376932459
Name:EUGENE ROYTMAN DMD, INC
Entity Type:Organization
Organization Name:EUGENE ROYTMAN DMD, INC
Other - Org Name:ALLEGRO DENTAL, PRACTICE OF EUGENE ROYTMAN DMD, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:415-584-8500
Mailing Address - Street 1:1866 B ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3139
Mailing Address - Country:US
Mailing Address - Phone:415-584-8500
Mailing Address - Fax:415-584-8554
Practice Address - Street 1:1866 B STREET
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541
Practice Address - Country:US
Practice Address - Phone:415-584-8500
Practice Address - Fax:415-584-8554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty