Provider Demographics
NPI:1700295771
Name:SUSAN L ROYER DDS PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SUSAN L ROYER DDS PROFESSIONAL CORPORATION
Other - Org Name:SUSAN L ROYER DDS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-663-4024
Mailing Address - Street 1:2587 W 65TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2833
Mailing Address - Country:US
Mailing Address - Phone:219-663-4024
Mailing Address - Fax:
Practice Address - Street 1:9291 E 109TH AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8676
Practice Address - Country:US
Practice Address - Phone:219-663-4024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009289261QD0000X
IL019022078261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental