Provider Demographics
NPI:1841836251
Name:WILLIAMSBURG DENTAL HEALTH CLINIC INC
Entity type:Organization
Organization Name:WILLIAMSBURG DENTAL HEALTH CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BENTON
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-668-9808
Mailing Address - Street 1:827 S HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:52361-9333
Mailing Address - Country:US
Mailing Address - Phone:319-668-9808
Mailing Address - Fax:319-668-9735
Practice Address - Street 1:827 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:IA
Practice Address - Zip Code:52361
Practice Address - Country:US
Practice Address - Phone:319-668-9808
Practice Address - Fax:319-668-9735
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAMSBURG DENTAL HEALTH CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-20
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment