Organization
ROANOKE SMILES YOUTH DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENELL STUMP (MANAGER)
(615) 750-0343
Entity
Organization
Contact information
Practice address
5002 AIRPORT RD NW, UNIT 130, ROANOKE, VA 24012-1608
(540) 362-5437
(540) 362-8997
Mailing address
16 ARCADE UNIT 198747, NASHVILLE, TN 37219-1994
(615) 750-0343
(615) 986-1705
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109481
—
VA
Enumeration date
10/11/2006
Last updated
07/09/2014
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