Provider Demographics
NPI:1114812849
Name:MILGRIM, ROYCE DARRIN (DMD)
Entity type:Individual
Prefix:
First Name:ROYCE
Middle Name:DARRIN
Last Name:MILGRIM
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:PO BOX 3849
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86302-3849
Mailing Address - Country:US
Mailing Address - Phone:575-200-9027
Mailing Address - Fax:
Practice Address - Street 1:1200 GAIL GARDNER WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-3430
Practice Address - Country:US
Practice Address - Phone:928-777-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD012554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist