Provider Demographics
NPI:1619356623
Name:MARTINSVILLE FAMILY DENTISTRY PC
Entity Type:Organization
Organization Name:MARTINSVILLE FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-632-6219
Mailing Address - Street 1:25 CLEVELAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-2935
Mailing Address - Country:US
Mailing Address - Phone:276-632-6219
Mailing Address - Fax:276-632-8356
Practice Address - Street 1:25 CLEVELAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2935
Practice Address - Country:US
Practice Address - Phone:276-632-6219
Practice Address - Fax:276-632-8356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty