Provider Demographics
NPI:1740244623
Name:ROYACK, GREGORY ALBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALBERT
Last Name:ROYACK
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:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337
Mailing Address - Country:US
Mailing Address - Phone:360-478-2366
Mailing Address - Fax:360-373-2096
Practice Address - Street 1:616 SIXTH STREET
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337
Practice Address - Country:US
Practice Address - Phone:360-478-2368
Practice Address - Fax:360-475-3700
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009399122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist