Provider Demographics
NPI:1720180821
Name:ROCKBRIDGE COUNTY DENTAL CLINIC
Entity Type:Organization
Organization Name:ROCKBRIDGE COUNTY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEYDARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-463-3185
Mailing Address - Street 1:300 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-1937
Mailing Address - Country:US
Mailing Address - Phone:540-463-2332
Mailing Address - Fax:540-463-6677
Practice Address - Street 1:300 WHITE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450
Practice Address - Country:US
Practice Address - Phone:540-463-2332
Practice Address - Fax:540-463-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410833251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare