Provider Demographics
NPI:1790015360
Name:ROY DANIELS DDS PLC
Entity Type:Organization
Organization Name:ROY DANIELS DDS PLC
Other - Org Name:ROY G DANIELS DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:GWENN
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-300-3546
Mailing Address - Street 1:130 NAVAJO DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-3718
Mailing Address - Country:US
Mailing Address - Phone:928-282-3246
Mailing Address - Fax:928-282-5846
Practice Address - Street 1:2235 CORRAL RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-3272
Practice Address - Country:US
Practice Address - Phone:928-300-3546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty