Provider Demographics
NPI:1669532560
Name:WASHINGTON CO HEALTH DEPT DENTAL CLINIC
Entity type:Organization
Organization Name:WASHINGTON CO HEALTH DEPT DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:H
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-781-7451
Mailing Address - Street 1:15068 LEE HIGHWAY
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202
Mailing Address - Country:US
Mailing Address - Phone:276-676-5604
Mailing Address - Fax:276-645-1994
Practice Address - Street 1:15068 LEE HIGHWAY
Practice Address - Street 2:SUITE 1000
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202
Practice Address - Country:US
Practice Address - Phone:276-676-5604
Practice Address - Fax:276-645-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010052171223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty