Healthcare Provider Details

I. General information

NPI: 1003886912
Provider Name (Legal Business Name): ALBERT W PARULIS JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6027 PETERS CREEK RD
ROANOKE VA
24019
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-362-5900
  • Fax: 540-366-5131
Mailing address:
  • Phone: 540-362-5900
  • Fax: 540-366-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401411233
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: