Provider Demographics
NPI:1922169978
Name:ROY E DAY
Entity Type:Organization
Organization Name:ROY E DAY
Other - Org Name:PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-599-5000
Mailing Address - Street 1:3000 HAMPTON CTR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1708
Mailing Address - Country:US
Mailing Address - Phone:304-599-5000
Mailing Address - Fax:304-599-6629
Practice Address - Street 1:3000 HAMPTON CTR
Practice Address - Street 2:SUITE B
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1708
Practice Address - Country:US
Practice Address - Phone:304-599-5000
Practice Address - Fax:304-599-6629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV35961223G0001X
WV21161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0012779000Medicaid
WV01525386OtherUNITED CONCORDIA GROUP