Provider Demographics
NPI:1760766711
Name:ROYAL DENTAL PC
Entity Type:Organization
Organization Name:ROYAL DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VAIJANTHI
Authorized Official - Middle Name:M
Authorized Official - Last Name:OZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-334-5500
Mailing Address - Street 1:530 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1607
Mailing Address - Country:US
Mailing Address - Phone:248-334-5500
Mailing Address - Fax:248-338-0500
Practice Address - Street 1:530 W HURON ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1607
Practice Address - Country:US
Practice Address - Phone:248-334-5500
Practice Address - Fax:248-338-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty