Provider Demographics
NPI:1457463184
Name:ROYAL, MATHEW JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:JOHN
Last Name:ROYAL
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 1:1835 COUNTY ROAD C W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1352
Mailing Address - Country:US
Mailing Address - Phone:651-746-0587
Mailing Address - Fax:
Practice Address - Street 1:1835 COUNTY ROAD C W
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1352
Practice Address - Country:US
Practice Address - Phone:651-746-0587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND113751223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics