Provider Demographics
NPI:1023466513
Name:SHENANDOAH ORAL AND FACIAL SURGERY, PLC
Entity type:Organization
Organization Name:SHENANDOAH ORAL AND FACIAL SURGERY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:QUITMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-433-1751
Mailing Address - Street 1:2031 LEGACY LANE
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-5431
Mailing Address - Country:US
Mailing Address - Phone:540-433-1751
Mailing Address - Fax:540-433-1756
Practice Address - Street 1:2031 LEGACY LANE
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-5431
Practice Address - Country:US
Practice Address - Phone:540-433-1751
Practice Address - Fax:540-433-1756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014150561223S0112X
VA0438000361204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty