Provider Demographics
NPI:1346416500
Name:DENTAL CLINIC OF NORTHERN SHENANDOAH VALLEY, INC
Entity Type:Organization
Organization Name:DENTAL CLINIC OF NORTHERN SHENANDOAH VALLEY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TALIAFERRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-869-2600
Mailing Address - Street 1:301 N CAMERON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6018
Mailing Address - Country:US
Mailing Address - Phone:540-536-1680
Mailing Address - Fax:
Practice Address - Street 1:301 N CAMERON ST STE 100
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6018
Practice Address - Country:US
Practice Address - Phone:540-536-1680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental