Provider Demographics
NPI:1447811070
Name:MAYALL, ROOP (DDS)
Entity type:Individual
Prefix:
First Name:ROOP
Middle Name:
Last Name:MAYALL
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 1:7717 OCEAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-6034
Mailing Address - Country:US
Mailing Address - Phone:530-220-2995
Mailing Address - Fax:
Practice Address - Street 1:1215 PLUMAS ST STE 52
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3492
Practice Address - Country:US
Practice Address - Phone:530-671-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1031211223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health