Eisa Jawad Abu Munshar
Individual provider Active NPI Dentist · Roanoke, VA
NPI 1770019622 · NPPES record last updated Jun 18, 2019
Key facts
- NPI
- 1770019622
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 0401416557 (VA)
- Practice address
- 4753 Valley View Blvd NW
Roanoke, VA 24012 - Phone
- (614) 282-0979
- NPI assigned
- May 11, 2017
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401416557 | VA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401416557 | VA | Yes |
Addresses
Primary practice location
4753 Valley View Blvd NW
Roanoke, VA 24012
Mailing address
4753 Valley View Blvd NW
Roanoke, VA 24012-2000
Other practice location 1
500 Gypsy Ln
Youngstown, OH 44504-1315
Phone (330) 884-3058
Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.