Provider Demographics
NPI:1912022922
Name:NELSON COUNTY DENTAL CLINIC
Entity Type:Organization
Organization Name:NELSON COUNTY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PEAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-972-6219
Mailing Address - Street 1:PO BOX 7546
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-7546
Mailing Address - Country:US
Mailing Address - Phone:434-972-6219
Mailing Address - Fax:434-972-4310
Practice Address - Street 1:1138 ROSE HILL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5128
Practice Address - Country:US
Practice Address - Phone:434-972-6219
Practice Address - Fax:434-972-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty