Provider Demographics
NPI:1295814770
Name:DANVILLE DENTAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:DANVILLE DENTAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:DILLON
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-799-8825
Mailing Address - Street 1:770 PINEY FOREST RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-2875
Mailing Address - Country:US
Mailing Address - Phone:434-799-8825
Mailing Address - Fax:434-799-9458
Practice Address - Street 1:770 PINEY FOREST RD
Practice Address - Street 2:SUITE A
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-2875
Practice Address - Country:US
Practice Address - Phone:434-799-8825
Practice Address - Fax:434-799-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty