Healthcare Provider Details

I. General information

NPI: 1104470657
Provider Name (Legal Business Name): ADAM PINK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 VALLEY VIEW BLVD NW STE 201
ROANOKE VA
24012-2022
US

IV. Provider business mailing address

696 SCARLET DR
DALEVILLE VA
24083-3175
US

V. Phone/Fax

Practice location:
  • Phone: 540-563-5858
  • Fax:
Mailing address:
  • Phone: 719-290-0478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401418246
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: