Healthcare Provider Details

I. General information

NPI: 1821068958
Provider Name (Legal Business Name): STEPHEN SMITH RADCLIFFE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 JESSIE DUPONT MEMORIAL HIGHWAY
BURGESS VA
22432-0628
US

IV. Provider business mailing address

PO BOX 628
BURGESS VA
22432-0628
US

V. Phone/Fax

Practice location:
  • Phone: 804-453-4361
  • Fax:
Mailing address:
  • Phone: 804-453-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401006554
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: