Provider Demographics
NPI:1700961588
Name:FAUQUIER COUNTY DENTAL CLINIC
Entity Type:Organization
Organization Name:FAUQUIER COUNTY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-347-6400
Mailing Address - Street 1:330 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186
Mailing Address - Country:US
Mailing Address - Phone:540-347-6400
Mailing Address - Fax:540-347-6405
Practice Address - Street 1:330 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186
Practice Address - Country:US
Practice Address - Phone:540-347-6400
Practice Address - Fax:540-347-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
0401006380OtherLIC NUMBER