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General NPI Number Information
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NPI Number | 1891976148
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Entity Type | Organization
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Legal Business Name | VALLEY ORAL SURGERY, P.C.
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 4437 STARKEY RD STE B
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City | ROANOKE
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State | VA
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Zip | 24018-0618
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Country | US
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Telephone | 540-774-5900
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Fax | 540-776-3496
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Provider Business Mailing Address
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Address Line | 4437 STARKEY RD STE B
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City | ROANOKE
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State | VA
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Zip | 24018-0618
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Country | US
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Telephone | 540-774-5900
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Fax | 540-776-3496
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CAROLINE D SHELL
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Credential |
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Telephone | 540-774-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401005671
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License Number State | VA
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