Provider Demographics
NPI:1104181254
Name:WRYTER, JULIET ADOBEA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIET
Middle Name:ADOBEA
Last Name:WRYTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 AIRPORT RD NW UNIT 130
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-1607
Mailing Address - Country:US
Mailing Address - Phone:540-362-5437
Mailing Address - Fax:540-362-8997
Practice Address - Street 1:5002 AIRPORT RD NW UNIT 130
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-1607
Practice Address - Country:US
Practice Address - Phone:540-362-5437
Practice Address - Fax:540-362-8997
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1104181254Medicaid