Provider Demographics
NPI:1477551562
Name:ROYAL, JOHN RALPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RALPH
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 1:179 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-3035
Mailing Address - Country:US
Mailing Address - Phone:719-433-1585
Mailing Address - Fax:
Practice Address - Street 1:179 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-3035
Practice Address - Country:US
Practice Address - Phone:719-955-4023
Practice Address - Fax:719-955-4046
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2020-11-02
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
NC12062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12062OtherNC LICENSE