Provider Demographics
NPI:1740382878
Name:RICHMOND COUNTY DENTAL CLINIC
Entity type:Organization
Organization Name:RICHMOND COUNTY DENTAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DEPT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-758-2381
Mailing Address - Street 1:5591 RICHMOND ROAD
Mailing Address - Street 2:P O BOX 700
Mailing Address - City:WARSAW
Mailing Address - State:VA
Mailing Address - Zip Code:22572
Mailing Address - Country:US
Mailing Address - Phone:804-758-2381
Mailing Address - Fax:
Practice Address - Street 1:5591 RICHMOND ROAD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:VA
Practice Address - Zip Code:22572
Practice Address - Country:US
Practice Address - Phone:804-758-2381
Practice Address - Fax:804-758-4828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THREE RIVERS HEALTH DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-01
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004548251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA106883OtherDORAL (VA SMILES)
VA8454510Medicaid