Provider Demographics
NPI:1386981041
Name:ROANE DENTAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:ROANE DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-717-7743
Mailing Address - Street 1:1855 TANNER WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8302
Mailing Address - Country:US
Mailing Address - Phone:865-717-7743
Mailing Address - Fax:865-717-6615
Practice Address - Street 1:1855 TANNER WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8302
Practice Address - Country:US
Practice Address - Phone:865-717-7743
Practice Address - Fax:865-717-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000093131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty