Provider Demographics
NPI:1639400575
Name:JOHN R. ROLLER AND ASSOCIATES
Entity Type:Organization
Organization Name:JOHN R. ROLLER AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ROLLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-943-1114
Mailing Address - Street 1:251 FRONTIER DR
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-9174
Mailing Address - Country:US
Mailing Address - Phone:540-886-3777
Mailing Address - Fax:540-886-3677
Practice Address - Street 1:251 FRONTIER DR
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-9174
Practice Address - Country:US
Practice Address - Phone:540-886-3777
Practice Address - Fax:540-886-3677
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN R. ROLLER, D.D.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty