Provider Demographics
NPI:1679241475
Name:ROY, MADHURA (DDS)
Entity type:Individual
Prefix:
First Name:MADHURA
Middle Name:
Last Name: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 1:3773 W INA RD STE 180
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2292
Mailing Address - Country:US
Mailing Address - Phone:520-579-8166
Mailing Address - Fax:
Practice Address - Street 1:3773 W INA RD
Practice Address - Street 2:SUITE 180
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741
Practice Address - Country:US
Practice Address - Phone:520-579-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-06
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist