Provider Demographics
NPI:1083802607
Name:E. ROSS TESTERMAN,JR.,D.D.S.,P.C.
Entity Type:Organization
Organization Name:E. ROSS TESTERMAN,JR.,D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:TESTERMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-885-1631
Mailing Address - Street 1:504 N COALTER ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-3401
Mailing Address - Country:US
Mailing Address - Phone:540-885-1631
Mailing Address - Fax:540-885-7015
Practice Address - Street 1:504 N COALTER ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3401
Practice Address - Country:US
Practice Address - Phone:540-885-1631
Practice Address - Fax:540-885-7015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005809302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization