Provider Demographics
NPI:1417431503
Name:LURAY DENTAL HEALTH CENTER, PC
Entity Type:Organization
Organization Name:LURAY DENTAL HEALTH CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-603-4763
Mailing Address - Street 1:33 N BANK ST
Mailing Address - Street 2:
Mailing Address - City:LURAY
Mailing Address - State:VA
Mailing Address - Zip Code:22835-1115
Mailing Address - Country:US
Mailing Address - Phone:703-895-5779
Mailing Address - Fax:
Practice Address - Street 1:33 N BANK ST
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1115
Practice Address - Country:US
Practice Address - Phone:703-895-5779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental