Healthcare Provider Details

I. General information

NPI: 1902767882
Provider Name (Legal Business Name): TRIAD ORTHODONTICS - DANVILLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 LOWES DR
DANVILLE VA
24540-5930
US

IV. Provider business mailing address

364 LOWES DR
DANVILLE VA
24540-5930
US

V. Phone/Fax

Practice location:
  • Phone: 434-354-0197
  • Fax:
Mailing address:
  • Phone: 434-354-0197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TERESA ZWICKY
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 480-866-8811