Provider Demographics
NPI:1003823394
Name:ROY, DARYL JON (DMD)
Entity type:Individual
Prefix:DR
First Name:DARYL
Middle Name:JON
Last Name:ROY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5105
Mailing Address - Country:US
Mailing Address - Phone:954-557-7440
Mailing Address - Fax:
Practice Address - Street 1:4431 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33308-5105
Practice Address - Country:US
Practice Address - Phone:954-557-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN106131223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics