Provider Demographics
NPI:1831644426
Name:ROACH, ABIGAIL BRIAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:BRIAR
Last Name:ROACH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ABIGAIL
Other - Middle Name:BRIAR
Other - Last Name:ESPINOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:11638 S MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2630
Mailing Address - Country:US
Mailing Address - Phone:865-898-5536
Mailing Address - Fax:
Practice Address - Street 1:430 STUART RD NE
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4992
Practice Address - Country:US
Practice Address - Phone:423-559-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist