Provider Demographics
NPI:1447477294
Name:ROY, CHARLES OVERTON (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:OVERTON
Last Name:ROY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 W CAUSEWAY APPROACH
Mailing Address - Street 2:SUITE C
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3022
Mailing Address - Country:US
Mailing Address - Phone:985-674-0060
Mailing Address - Fax:985-674-0636
Practice Address - Street 1:1510 W CAUSEWAY APPROACH
Practice Address - Street 2:SUITE C
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3022
Practice Address - Country:US
Practice Address - Phone:985-674-0060
Practice Address - Fax:985-674-0636
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA49891223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics