Provider Demographics
NPI:1710040191
Name:LYNCHBURG HEALTH DEPT. DENTAL OFFICE
Entity Type:Organization
Organization Name:LYNCHBURG HEALTH DEPT. DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CENTRAL VA. HEALTH DISTRIC
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:V
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-947-6777
Mailing Address - Street 1:1900 THOMSON DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1009
Mailing Address - Country:US
Mailing Address - Phone:434-947-6777
Mailing Address - Fax:
Practice Address - Street 1:1900 THOMSON DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1009
Practice Address - Country:US
Practice Address - Phone:434-947-6777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LYNCHBURG HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-18
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare