| NPI | 1558078857 |
|---|---|
| Doing Business As | NORTHEAST ROANOKE DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | JAMES WILLIS CEO 304-685-5980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2022-11-04 |