Provider Demographics
NPI:1457484008
Name:MCNITT, ROY H (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:H
Last Name:MCNITT
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 1:12482 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-7688
Mailing Address - Country:US
Mailing Address - Phone:815-389-4480
Mailing Address - Fax:
Practice Address - Street 1:3535 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-2199
Practice Address - Country:US
Practice Address - Phone:815-877-7411
Practice Address - Fax:815-877-5001
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice