Organization
ROANOKE PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COREY JOE SHEPPARD DDS (OWNER)
(540) 563-1660
Entity
Organization
Contact information
Practice address
6112 PETERS CREEK RD, ROANOKE, VA 24019-4028
(540) 563-1660
Mailing address
6112 PETERS CREEK RD, ROANOKE, VA 24019-4028
(540) 563-1660
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
0401413481
VA
Other
Enumeration date
10/02/2017
Last updated
10/02/2017
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