Provider Demographics
NPI:1629376306
Name:ROYCE, LEAH SUSANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:SUSANNE
Last Name:ROYCE
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 1:10408 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3818
Mailing Address - Country:US
Mailing Address - Phone:301-649-7483
Mailing Address - Fax:
Practice Address - Street 1:5100 WISCONSIN AVE NW STE 240
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4126
Practice Address - Country:US
Practice Address - Phone:202-686-2318
Practice Address - Fax:202-686-4059
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN55091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice