Provider Demographics
NPI:1942213442
Name:BLEDSOE, ROY WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:WILLIAM
Last Name:BLEDSOE
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 1:104 NORTH COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4701
Mailing Address - Country:US
Mailing Address - Phone:972-783-8811
Mailing Address - Fax:972-680-1024
Practice Address - Street 1:104 NORTH COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4701
Practice Address - Country:US
Practice Address - Phone:972-783-8811
Practice Address - Fax:972-680-1024
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX91841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics