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General NPI Number Information
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NPI Number | 1669871968
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Entity Type | Organization
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Legal Business Name | TREMONT ROAD DENTAL, PC
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Dates
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Enumeration Date | 08/22/2014
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Last Update Date | 05/27/2022
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Provider Practice Location Address
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Address Line | 5002 AIRPORT RD NW UNIT 130
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City | ROANOKE
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State | VA
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Zip | 24012-1607
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Country | US
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Telephone | 770-916-5031
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Fax |
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Provider Business Mailing Address
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Address Line | 1090 NORTHCHASE PKWY SE SUITE 150
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City | MARIETTA
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State | GA
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Zip | 30067-6405
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PAYOR RELATIONS
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Name | MICHELLE JACOMINO
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Credential |
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Telephone | 770-916-5036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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