Provider Demographics
NPI:1740554302
Name:FAMILY DENTAL CLINIC OF THE NEW RIVER VALLEY, INC.
Entity type:Organization
Organization Name:FAMILY DENTAL CLINIC OF THE NEW RIVER VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-381-0820
Mailing Address - Street 1:215 ROANOKE ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3025
Mailing Address - Country:US
Mailing Address - Phone:540-381-0820
Mailing Address - Fax:540-382-3391
Practice Address - Street 1:215 ROANOKE ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3025
Practice Address - Country:US
Practice Address - Phone:540-381-0820
Practice Address - Fax:540-382-3391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREE CLINIC OF THE NEW RIVER VALLEY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental