EWING JACKSON THREET

ROANOKE, VA
NPI1164954582
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy125Q00000X Oral Medicine
(Licence: VA  0401417624)
Additional Taxonomies122300000X Dentist
(Licence: VA  0401417624)
Enumeration Date2017-04-03
Last Update Date2023-03-09
Business Address
EWING JACKSON THREET DMD
1111 S JEFFERSON ST
ROANOKE, VA 24016-4724
Phone number: 276-632-2634
Mailing Address
EWING JACKSON THREET DMD
1111 S JEFFERSON ST
ROANOKE, VA 24016-4724
Phone number: