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Export Provider Record NPI 1104007384
Roanoke Oral Surgery, Inc.
Organization Subpart: NO
Active
NPI Number1104007384
NPI TypeNPI-2 Organization
SpecialtyDentist, Oral and Maxillofacial Surgery
Provider Details
NPI1104007384
NPI TypeNPI-2 Organization
StatusActive
Enumeration Date2007-11-16
Last Updated2007-11-16
Authorized OfficialJames Mcclung
President
Phone: 5403625900
Mailing AddressPo Box 7889
Roanoke, VA 24019-0889
United States
Phone: (540) 362-5900 | Fax: (540) 366-5131
📍 View Map
Primary Practice Address6027 Peters Creek Rd
Roanoke, VA 24019-4029
United States
Phone: (540) 362-5900 | Fax: (540) 366-5131
📍 View Map
Taxonomy / Specialty
PrimaryTaxonomy Code & DescriptionStateLicense Number
Yes1223S0112X – Dentist, Oral and Maxillofacial SurgeryVA0401004673
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About NPI 1104007384

Roanoke Oral Surgery, Inc. is an organization registered in the CMS NPPES NPI Registry with NPI number 1104007384. The primary specialty listed is Dentist, Oral and Maxillofacial Surgery. The organization is located in Roanoke, VA. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2007-11-16. All data is sourced directly from the official CMS NPPES public API and is updated daily.

Frequently Asked Questions

What is NPI 1104007384?

NPI 1104007384 belongs to Roanoke Oral Surgery, Inc., a Dentist, Oral and Maxillofacial Surgery in Roanoke, VA. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.

Is NPI 1104007384 active?

The current status of NPI 1104007384 in the NPPES registry is Active. The record was last updated on 2007-11-16.

What specialty is NPI 1104007384?

NPI 1104007384 is classified under the taxonomy Dentist, Oral and Maxillofacial Surgery. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.

How do I verify NPI 1104007384?

You can verify NPI 1104007384 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.

What address is on file for NPI 1104007384?

The primary practice address on file for NPI 1104007384 is 6027 Peters Creek Rd, Roanoke, VA 24019-4029. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.

When was NPI 1104007384 issued?

NPI 1104007384 was first issued (enumerated) on 2007-11-16. The NPPES record was last updated on 2007-11-16.

Practice Location Map

Roanoke Oral Surgery, Inc. is located at 6027 Peters Creek Rd, Roanoke, VA. Use the map below to find directions or verify the practice location.

📍 6027 Peters Creek Rd, Roanoke, VA 24019-4029  ·  Open in Google Maps ↗

Related Healthcare Providers

The following providers share the same practice location, specialty, or state as Roanoke Oral Surgery, Inc.. All records sourced from the CMS NPPES registry.

License Information

The following state license numbers are on file in the NPPES registry for NPI 1104007384. For license status verification, contact the relevant state licensing board directly.

Specialty / TaxonomyLicense NumberState
Dentist, Oral and Maxillofacial Surgery0401004673VA
Data Verified from CMS NPPES Last synced: 2026-06-24 · Source: npiregistry.cms.hhs.gov · 45 CFR Part 162