Provider Demographics
NPI:1144564634
Name:BLUE RIDGE FREE DENTAL CLINIC
Entity Type:Organization
Organization Name:BLUE RIDGE FREE DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTO
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-743-3393
Mailing Address - Street 1:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:CASHIERS
Mailing Address - State:NC
Mailing Address - Zip Code:28717-0451
Mailing Address - Country:US
Mailing Address - Phone:828-743-3393
Mailing Address - Fax:828-743-5038
Practice Address - Street 1:130 US HWY 64 EAST UNIT 12
Practice Address - Street 2:LAUREL TERRACE
Practice Address - City:CASHIERS
Practice Address - State:NC
Practice Address - Zip Code:28717
Practice Address - Country:US
Practice Address - Phone:828-743-3393
Practice Address - Fax:828-743-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty