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General NPI Number Information
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NPI Number | 1467052019
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Entity Type | Organization
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Legal Business Name | PARKWAY PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 10/31/2020
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 3650 COLONIAL AVE
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City | ROANOKE
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State | VA
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Zip | 24018-4004
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Country | US
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Telephone | 540-989-3639
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Fax |
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Provider Business Mailing Address
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Address Line | 5907 CAVALIER DR
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City | ROANOKE
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State | VA
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Zip | 24018-3863
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Country | US
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Telephone | 701-212-7428
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | RYAN R REOPELLE
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Credential | DDS
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Telephone | 701-212-7428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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