Provider Demographics
NPI:1104831635
Name:CENTRAL VIRGINIA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA FAMILY DENTISTRY
Other - Org Name:DAVIS AND HOWARD LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLAIRBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-237-0004
Mailing Address - Street 1:20936 TIMBERLAKE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502
Mailing Address - Country:US
Mailing Address - Phone:434-237-0004
Mailing Address - Fax:434-237-6597
Practice Address - Street 1:20936 TIMBERLAKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502
Practice Address - Country:US
Practice Address - Phone:434-237-0004
Practice Address - Fax:434-237-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005086122300000X
VA0401410751122300000X
VA0401410958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty