Provider Demographics
NPI:1477551562
Name:ROYAL, JOHN RALPH (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RALPH
Last Name:ROYAL
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 1:313 SAYLOR HILL RD
Mailing Address - Street 2:
Mailing Address - City:LIMESTONE
Mailing Address - State:TN
Mailing Address - Zip Code:37681-2227
Mailing Address - Country:US
Mailing Address - Phone:423-905-8883
Mailing Address - Fax:423-933-3726
Practice Address - Street 1:117 WEST SEVIER AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660
Practice Address - Country:US
Practice Address - Phone:423-933-3773
Practice Address - Fax:423-933-3726
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2024-11-27
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
TN45431223G0001X
NC12062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12062OtherNC LICENSE