| NPI | 1093044406 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY A ROACH Owner/President 540-774-1019 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401007932) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA 0401411406) |
| 122300000X Dentist (Licence: WV 0401008066) | |
| Enumeration Date | 2009-12-14 |
| Last Update Date | 2009-12-14 |