Provider Demographics
NPI:1114225091
Name:PIEDMONT REGIONAL DENTAL CLINIC INC
Entity Type:Organization
Organization Name:PIEDMONT REGIONAL DENTAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINTERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-661-0008
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960-0087
Mailing Address - Country:US
Mailing Address - Phone:540-661-0008
Mailing Address - Fax:
Practice Address - Street 1:13296 JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960-2810
Practice Address - Country:US
Practice Address - Phone:540-661-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental