Provider Demographics
NPI:1477621290
Name:ROY D MCANNELLY DMD PC
Entity Type:Organization
Organization Name:ROY D MCANNELLY DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCANNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:248-647-0696
Mailing Address - Street 1:50 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304
Mailing Address - Country:US
Mailing Address - Phone:248-647-0696
Mailing Address - Fax:248-647-3257
Practice Address - Street 1:50 W BIG BEAVER RD
Practice Address - Street 2:SUITE 215
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304
Practice Address - Country:US
Practice Address - Phone:248-647-0696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011253 0935920122300000X
MI2901011253 09367121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty