Provider Demographics
NPI:1164920062
Name:AESTHETIC & FAMILY DENTAL OF MARTINSVILLE PC
Entity Type:Organization
Organization Name:AESTHETIC & FAMILY DENTAL OF MARTINSVILLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ALLAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:276-638-3265
Mailing Address - Street 1:5 DUDLEY STREET
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112
Mailing Address - Country:US
Mailing Address - Phone:276-638-3265
Mailing Address - Fax:276-656-1190
Practice Address - Street 1:5 DUDLEY STREET
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112
Practice Address - Country:US
Practice Address - Phone:276-638-3265
Practice Address - Fax:276-656-1190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AESTHETIC & FAMILY DENTAL OF MARTINSVILLE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty