Provider Demographics
NPI:1144437666
Name:SCORDAS, CHRIS G (DDS)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:G
Last Name:SCORDAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 STEPHENSON AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1660
Mailing Address - Country:US
Mailing Address - Phone:540-342-5593
Mailing Address - Fax:
Practice Address - Street 1:2110 STEPHENSON AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1660
Practice Address - Country:US
Practice Address - Phone:540-342-5593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401002280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401002280OtherLICENSE