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General NPI Number Information
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NPI Number | 1831644426
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Entity Type | Individual
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Provider Name | ABIGAIL BRIAR ROACH D.D.S
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Gender | Female
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 430 STUART RD NE SUITE 1
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City | CLEVELAND
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State | TN
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Zip | 37312-4992
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Country | US
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Telephone | 423-559-0157
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Fax |
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Provider Business Mailing Address
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Address Line | 11638 S MONTICELLO DR
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City | KNOXVILLE
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State | TN
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Zip | 37934-2630
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Country | US
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Telephone | 865-898-5536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0401415319
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License Number State | VA
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