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General NPI Number Information
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NPI Number | 1700283082
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Entity Type | Organization
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Legal Business Name | ROANOKE VALLEY DENTAL
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 1618 GRANDIN RD SW
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City | ROANOKE
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State | VA
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Zip | 24015-2308
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Country | US
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Telephone | 540-345-4894
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Fax |
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Provider Business Mailing Address
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Address Line | 1618 GRANDIN RD SW
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City | ROANOKE
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State | VA
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Zip | 24015-2308
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Country | US
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Telephone | 540-345-4894
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. ALICE BOWER
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Credential | D.D.S.
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Telephone | 540-345-4894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401413402
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License Number State | VA
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