Provider Demographics
NPI:1073706586
Name:KIMBERLYN R. ATHERTON DDS, PC
Entity Type:Organization
Organization Name:KIMBERLYN R. ATHERTON DDS, PC
Other - Org Name:NEW RIVER VALLEY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ATHERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:540-951-2260
Mailing Address - Street 1:1400 S MAIN ST
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-5528
Mailing Address - Country:US
Mailing Address - Phone:540-951-2260
Mailing Address - Fax:540-951-2268
Practice Address - Street 1:1400 S MAIN ST
Practice Address - Street 2:SUITE 1401
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-5528
Practice Address - Country:US
Practice Address - Phone:540-951-2260
Practice Address - Fax:540-951-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410261261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental