Provider Demographics
NPI:1124202395
Name:DIANN M VILD
Entity Type:Organization
Organization Name:DIANN M VILD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANN
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:VILD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-786-2311
Mailing Address - Street 1:4805 PLANK ROAD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407
Mailing Address - Country:US
Mailing Address - Phone:540-786-2311
Mailing Address - Fax:540-786-9151
Practice Address - Street 1:4805 PLANK ROAD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407
Practice Address - Country:US
Practice Address - Phone:540-786-2311
Practice Address - Fax:540-786-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty