Provider Demographics
NPI:1639751571
Name:FAULKS, ROY LEE III (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:LEE
Last Name:FAULKS
Suffix:III
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 BUSH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-4805
Mailing Address - Country:US
Mailing Address - Phone:803-798-0894
Mailing Address - Fax:
Practice Address - Street 1:3527 BUSH RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4805
Practice Address - Country:US
Practice Address - Phone:803-798-0894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2025-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC111481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics