MEDICARE: DR. ABIGAIL BRIAR ROACH D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401415319	VA

General Provider Information

NPI Number	:	1831644426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABIGAIL BRIAR ROACH D.D.S

Provider Business Mailing Address
First Line	:	11638 S MONTICELLO DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37934-2630
Country	:	US
Telephone Number	:	865-898-5536
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 STUART RD NE
Second Line	:	SUITE 1
City	:	CLEVELAND
State	:	TN
Zip	:	37312-4992
Country	:	US
Telephone Number	:	423-559-0157
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	01/24/2017

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