| Roanoke Smiles Youth Dentistry, Llc | |
|
5002 Airport Rd Nw Unit 130 Roanoke VA 24012-1608 | |
| (540) 362-5437 | |
| (540) 362-8997 |
| Full Name | Roanoke Smiles Youth Dentistry, Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5002 Airport Rd Nw, Roanoke, Virginia |
| Authorized Official Name and Position | Jenell Stump (MANAGER) |
| Authorized Official Contact | 6157500343 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Roanoke Smiles Youth Dentistry, Llc 16 Arcade Unit 198747 Nashville TN 37219-1994 Ph: (615) 750-0343 | Roanoke Smiles Youth Dentistry, Llc 5002 Airport Rd Nw Unit 130 Roanoke VA 24012-1608 Ph: (540) 362-5437 |
| NPI Number | 1851489116 |
|---|---|
| Provider Enumeration Date | 10/11/2006 |
| Last Update Date | 07/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851489116 | NPI | - | NPPES |
| 109481 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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