Provider Demographics
NPI:1932121266
Name:GROY, DAVID S (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:GROY
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 1:18 WIRT ST SW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-2915
Mailing Address - Country:US
Mailing Address - Phone:703-777-5600
Mailing Address - Fax:
Practice Address - Street 1:18 WIRT ST SW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2915
Practice Address - Country:US
Practice Address - Phone:703-777-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010055971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7816421Medicaid