Healthcare Provider Details

I. General information

NPI: 1962706754
Provider Name (Legal Business Name): STRAIGHT SMILES OF ROANOKE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 WILLIAMSON RD NE SUITE A
ROANOKE VA
24012-5130
US

IV. Provider business mailing address

16 ARCADE UNIT 198747
NASHVILLE TN
37219-1994
US

V. Phone/Fax

Practice location:
  • Phone: 540-206-2203
  • Fax: 540-400-0525
Mailing address:
  • Phone: 615-750-0343
  • Fax: 615-986-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JENELL STRINGER
Title or Position: MANAGER, LICENSING & CREDENTIALING
Credential:
Phone: 615-750-0343