# GARY A. ROACH, DDS, LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093044406
- **Authorized official:** DR. GARY A ROACH DDS (OWNER/PRESIDENT)
- **Authorized official phone:** (540) 774-1019

## Contact information

- **Practice address:** 5004 BRAMBLETON AVE, ROANOKE, VA 24018-4642
- **Practice address phone:** (540) 774-1019
- **Practice address fax:** (540) 774-9012
- **Mailing address:** 5004 BRAMBLETON AVE, ROANOKE, VA 24018-4642
- **Mailing address phone:** (540) 774-1019
- **Mailing address fax:** (540) 774-9012

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401007932 | VA | Yes |
| 122300000X | Dentist | 0401008066 | WV | — |
| 122300000X | Dentist | 0401411406 | PA | — |

## Other

- **Enumeration date:** 12/14/2009
- **Last updated:** 12/14/2009