NPIMap

Individual provider Active NPI

Amber Therese Royal, DDS

  • Dentist
  • Woodlawn, MD
National Provider Identifier
1437468576
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
15119 Issued in MD
Practice address
6618A Security Blvd
Woodlawn, MD 21207-4010
Phone
(410) 575-1833
Fax
(410) 803-5297
NPI assigned
Oct 6, 2010
Last updated
Feb 19, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 60745 KS
Dentist 122300000X 15119 MD Primary

Addresses

Primary practice location

6618A Security Blvd
Woodlawn, MD 21207-4010

Mailing address

6618A Security Blvd
Woodlawn, MD 21207-4010
Phone (410) 575-1833

Other identifiers 2

IdentifierTypeStateIssuer
201214960AMedicaidKS
058053800MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
60745KSMDDentist
15119MDMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Smile Street Dental CurrentSince Feb 23, 2020 Accepting new patients
Adventure Vision Parklane LLC Past Accepting new patients
Adventure Vision LLC Past Accepting new patients

Locations

6618A Security Blvd
Woodlawn, MD 21207
Phone (410) 575-1833

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582070400000",
    "number": "1437468576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6618A SECURITY BLVD",
            "city": "WOODLAWN",
            "state": "MD",
            "postal_code": "212074010",
            "telephone_number": "410-575-1833",
            "fax_number": "410-803-5297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6618A SECURITY BLVD",
            "city": "WOODLAWN",
            "state": "MD",
            "postal_code": "212074010",
            "telephone_number": "410-575-1833",
            "fax_number": "410-803-5297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROYAL",
        "first_name": "AMBER",
        "middle_name": "THERESE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-06",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "60745",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "15119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201214960A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058053800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodlawn, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.