Provider Demographics
NPI:1417149436
Name:DENTAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOSKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-389-0225
Mailing Address - Street 1:403 ROANOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5007
Mailing Address - Country:US
Mailing Address - Phone:540-389-0225
Mailing Address - Fax:540-389-3529
Practice Address - Street 1:403 ROANOKE BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5007
Practice Address - Country:US
Practice Address - Phone:540-389-0225
Practice Address - Fax:540-389-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty