Provider Demographics
NPI:1700092681
Name:PIEDMONT PLASTIC & ORAL SURGERY CENTER
Entity Type:Organization
Organization Name:PIEDMONT PLASTIC & ORAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:704-754-2679
Mailing Address - Street 1:330 JAKE ALEXANDER BLVD W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-1384
Mailing Address - Country:US
Mailing Address - Phone:704-754-2679
Mailing Address - Fax:704-637-2351
Practice Address - Street 1:330 JAKE ALEXANDER BLVD W
Practice Address - Street 2:SUITE 103
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1384
Practice Address - Country:US
Practice Address - Phone:704-754-2679
Practice Address - Fax:704-637-2351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty