=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417007295
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEMTNER & SEMTNER, DDS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2007
-----------------------------------------------------
Last Update Date | 05/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4370 STARKEY RD STE 1B
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018-0603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-989-0112
-----------------------------------------------------
Fax | 540-989-0049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4370 STARKEY RD STE 1B
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018-0603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-989-0112
-----------------------------------------------------
Fax | 540-989-0049
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROBERT B SEMTNER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 540-989-0112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0401410235
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0401410195
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------