Provider Demographics
NPI:1952572869
Name:ROY, NICHOLAS KEITH (DMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:KEITH
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 1:440 NARRAGANSETT TRAIL
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:ME
Mailing Address - Zip Code:04093
Mailing Address - Country:US
Mailing Address - Phone:207-929-3900
Mailing Address - Fax:207-929-3907
Practice Address - Street 1:440 NARRAGANSETT TRL
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-6505
Practice Address - Country:US
Practice Address - Phone:207-929-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118931223G0001X
MEDEN40901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1497091342OtherDENTISTRY