MEDICARE: VALLEY ORAL SURGERY, P.C.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	0401005671	VA

General Provider Information

NPI Number	:	1891976148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY ORAL SURGERY, P.C.

Provider Business Mailing Address
First Line	:	4437 STARKEY RD STE B
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-0618
Country	:	US
Telephone Number	:	540-774-5900
Fax Number	:	540-776-3496

Provider Business Practice Location Address
First Line	:	4437 STARKEY RD STE B
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-0618
Country	:	US
Telephone Number	:	540-774-5900
Fax Number	:	540-776-3496

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. CAROLINE D SHELL
Credential	:
Telephone Number	:	540-774-5900

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	03/11/2008

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