Provider Demographics
NPI:1417203415
Name:MAYNARD, ROY DOUGLAS JR (DDS)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:DOUGLAS
Last Name:MAYNARD
Suffix:JR
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 1:821 KING GEORGE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-8329
Mailing Address - Country:US
Mailing Address - Phone:912-927-8484
Mailing Address - Fax:912-927-8487
Practice Address - Street 1:821 KING GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-8328
Practice Address - Country:US
Practice Address - Phone:912-927-8484
Practice Address - Fax:912-927-8487
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0144491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice