Provider Demographics
NPI:1831141035
Name:WASHBURN, ROY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:S
Last Name:WASHBURN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROY
Other - Middle Name:S
Other - Last Name:WASHBURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3110 WEBB AVE
Mailing Address - Street 2:#300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3434
Mailing Address - Country:US
Mailing Address - Phone:214-528-7870
Mailing Address - Fax:214-526-1761
Practice Address - Street 1:3110 WEBB AVE
Practice Address - Street 2:#300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3434
Practice Address - Country:US
Practice Address - Phone:214-528-7870
Practice Address - Fax:214-526-1761
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice