Provider Demographics
NPI:1497187769
Name:PIEDMONT PEDIATRIC DENTISTRY PLC
Entity Type:Organization
Organization Name:PIEDMONT PEDIATRIC DENTISTRY PLC
Other - Org Name:PIEDMONT PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARRETT
Authorized Official - Middle Name:W R
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:434-973-4344
Mailing Address - Street 1:240 HYDRAULIC RIDGE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8130
Mailing Address - Country:US
Mailing Address - Phone:434-973-4344
Mailing Address - Fax:434-973-4675
Practice Address - Street 1:240 HYDRAULIC RIDGE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8130
Practice Address - Country:US
Practice Address - Phone:434-973-4344
Practice Address - Fax:434-973-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413204261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental