Provider Demographics
NPI:1821650607
Name:NEW RIVER VALLEY DENTAL, PLLC
Entity Type:Organization
Organization Name:NEW RIVER VALLEY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-685-6879
Mailing Address - Street 1:2513 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-8256
Mailing Address - Country:US
Mailing Address - Phone:719-685-6879
Mailing Address - Fax:
Practice Address - Street 1:1400 S MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-5506
Practice Address - Country:US
Practice Address - Phone:540-951-2260
Practice Address - Fax:540-951-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1134615321OtherNPI