Provider Demographics
NPI:1538320635
Name:ROYER, SUSAN L (DDS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:ROYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2587 W 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2833
Mailing Address - Country:US
Mailing Address - Phone:219-663-4024
Mailing Address - Fax:
Practice Address - Street 1:9291 E 109TH AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8676
Practice Address - Country:US
Practice Address - Phone:219-663-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120092891223G0001X
IL0190220781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice