NPIMap

Organization Active NPI

Gary a. Roach, DDS, LTD

  • Dentist
  • Roanoke, VA
National Provider Identifier
1093044406
Registry record updated Dec 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401007932 Issued in VA
Legal business name
GARY A. ROACH, DDS, LTD
Practice address
5004 Brambleton Ave
Roanoke, VA 24018-4642
Phone
(540) 774-1019
Fax
(540) 774-9012
NPI assigned
Dec 14, 2009
Last updated
Dec 14, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gary A Roach, DDSNPI 1598826281
Title
Owner/President
Phone
(540) 774-1019

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401007932 VA Primary
Dentist 122300000X 0401411406 PA
Dentist 122300000X 0401008066 WV

Addresses

Primary practice location

5004 Brambleton Ave
Roanoke, VA 24018-4642

Mailing address

5004 Brambleton Ave
Roanoke, VA 24018-4642
Phone (540) 774-1019

National Provider Directory

National Provider Directory

Locations

5004 Brambleton Ave
Roanoke, VA 24018
Phone (540) 774-1019

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1260748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260748800000",
    "number": "1093044406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5004 BRAMBLETON AVE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184642",
            "telephone_number": "540-774-1019",
            "fax_number": "540-774-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5004 BRAMBLETON AVE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240184642",
            "telephone_number": "540-774-1019",
            "fax_number": "540-774-9012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY A. ROACH, DDS, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-14",
        "last_updated": "2009-12-14",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "540-774-1019",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401007932",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "0401411406",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WV",
            "license": "0401008066",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.