Provider Demographics
NPI:1396815080
Name:RADFORD FAMILY DENTAL, INC.
Entity Type:Organization
Organization Name:RADFORD FAMILY DENTAL, INC.
Other - Org Name:DRS. HILTON, GRAHAM, SEMONES, HILTON, & YOUNG, DENTISTS, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHAMHORST
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-639-1674
Mailing Address - Street 1:1151 E MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1761
Mailing Address - Country:US
Mailing Address - Phone:540-639-1674
Mailing Address - Fax:
Practice Address - Street 1:1151 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1761
Practice Address - Country:US
Practice Address - Phone:540-639-1674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty