Provider Demographics
NPI:1750403754
Name:VAN ROY, LAURA (DDS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VAN ROY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8741 BROOKS RD S
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-7847
Mailing Address - Country:US
Mailing Address - Phone:707-838-1686
Mailing Address - Fax:
Practice Address - Street 1:8741 BROOKS RD S
Practice Address - Street 2:SUITE 202
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-7847
Practice Address - Country:US
Practice Address - Phone:707-838-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry