Provider Demographics
NPI:1295202844
Name:MASSANUTTEN DENTAL TEAM AND ORAL SURGERY
Entity Type:Organization
Organization Name:MASSANUTTEN DENTAL TEAM AND ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLADAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-432-0609
Mailing Address - Street 1:4100 QUARLES CT
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8797
Mailing Address - Country:US
Mailing Address - Phone:540-432-0609
Mailing Address - Fax:540-432-9097
Practice Address - Street 1:4100 QUARLES CT
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8797
Practice Address - Country:US
Practice Address - Phone:540-432-0609
Practice Address - Fax:540-432-9097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty