Provider Demographics
NPI:1922599349
Name:BLUE RIDGE DENTAL CARE LLC
Entity Type:Organization
Organization Name:BLUE RIDGE DENTAL CARE LLC
Other - Org Name:BLUE RIDGE DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:REA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-794-5994
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:17214-0621
Mailing Address - Country:US
Mailing Address - Phone:717-794-5994
Mailing Address - Fax:
Practice Address - Street 1:14989 BUCHANAN TRL E
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:17214-9775
Practice Address - Country:US
Practice Address - Phone:717-794-5994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental