| Roanoke Oral Surgery, Inc. | |
|
6027 Peters Creek Rd Roanoke VA 24019-4029 | |
| (540) 362-5900 | |
| (540) 366-5131 |
| Full Name | Roanoke Oral Surgery, Inc. |
|---|---|
| Speciality | Dentist |
| Location | 6027 Peters Creek Rd, Roanoke, Virginia |
| Authorized Official Name and Position | James T. Mcclung (PRESIDENT) |
| Authorized Official Contact | 5403625900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roanoke Oral Surgery, Inc. Po Box 7889 Roanoke VA 24019-0889 Ph: (540) 362-5900 | Roanoke Oral Surgery, Inc. 6027 Peters Creek Rd Roanoke VA 24019-4029 Ph: (540) 362-5900 |
| NPI Number | 1104007384 |
|---|---|
| Provider Enumeration Date | 11/16/2007 |
| Last Update Date | 11/16/2007 |
| Medicare PECOS PAC ID | 1456314681 |
|---|---|
| Medicare Enrollment ID | O20041109000755 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104007384 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 0401004673 (Virginia) | Primary |
| Provider Name | Albert W Parulis |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1003886912 PECOS PAC ID: 7719995869 Enrollment ID: I20060330000544 |
| Provider Name | Jason I Margolis |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1437315702 PECOS PAC ID: 6103074257 Enrollment ID: I20130912000717 |
| Provider Name | Kaine Ks Stokes |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1326236845 PECOS PAC ID: 6608122833 Enrollment ID: I20180702001170 |
| Provider Name | Nicole M Reddout |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1790001436 PECOS PAC ID: 6800261652 Enrollment ID: I20230407001127 |
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