Provider Demographics
NPI:1811060676
Name:RAPPAHANNOCK COUNTY DENTAL CLINIC
Entity type:Organization
Organization Name:RAPPAHANNOCK 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:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22747
Mailing Address - Country:US
Mailing Address - Phone:540-675-3516
Mailing Address - Fax:540-675-1021
Practice Address - Street 1:34 SCHOOLHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:VA
Practice Address - Zip Code:22747
Practice Address - Country:US
Practice Address - Phone:540-675-3516
Practice Address - Fax:540-675-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
0401006380OtherLIC #
VA4975898Medicaid