Provider Demographics
NPI:1619167319
Name:REPASS, JOHN SCOTT SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:REPASS
Suffix:SR
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 1:102 HIGHLAND AVE SE
Mailing Address - Street 2:301 COMMUNITY MEDICAL BLDG
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24013-2253
Mailing Address - Country:US
Mailing Address - Phone:540-343-1769
Mailing Address - Fax:540-342-1606
Practice Address - Street 1:102 HIGHLAND AVE SE
Practice Address - Street 2:301 COMMUNITY MEDICAL BLDG
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-2253
Practice Address - Country:US
Practice Address - Phone:540-343-1769
Practice Address - Fax:540-342-1606
Is Sole Proprietor?:No
Enumeration Date:2007-07-29
Last Update Date:2007-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401003883122300000X
VA38831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery