Healthcare Provider Details

I. General information

NPI: 1104181254
Provider Name (Legal Business Name): JULIET ADOBEA WRYTER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 AIRPORT RD NW UNIT 130
ROANOKE VA
24012-1607
US

IV. Provider business mailing address

5002 AIRPORT RD NW UNIT 130
ROANOKE VA
24012-1607
US

V. Phone/Fax

Practice location:
  • Phone: 540-362-5437
  • Fax: 540-362-8997
Mailing address:
  • Phone: 540-362-5437
  • Fax: 540-362-8997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401414175
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: