Provider Demographics
NPI:1508186008
Name:ROLLER, JOHN DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DANIEL
Last Name:ROLLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-3624
Mailing Address - Country:US
Mailing Address - Phone:540-943-1114
Mailing Address - Fax:540-943-1466
Practice Address - Street 1:1420 13TH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-3624
Practice Address - Country:US
Practice Address - Phone:540-943-1114
Practice Address - Fax:540-943-1466
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist