MEDICARE: STARKEY ROAD DENTAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1518143585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARKEY ROAD DENTAL, INC.

Provider Business Mailing Address
First Line	:	4370 STARKEY RD STE 2
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-0603
Country	:	US
Telephone Number	:	540-774-0042
Fax Number	:	540-774-0047

Provider Business Practice Location Address
First Line	:	4370 STARKEY RD STE 2
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-0603
Country	:	US
Telephone Number	:	540-774-0042
Fax Number	:	540-774-0047

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT B SEMTNER
Credential	:	DDS
Telephone Number	:	540-989-0112

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	01/21/2008

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