Healthcare Provider Details

I. General information

NPI: 1336306125
Provider Name (Legal Business Name): HARRISONBURG ROCKINGHAM DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W WATER ST
HARRISONBURG VA
22801-3624
US

IV. Provider business mailing address

25 W WATER ST
HARRISONBURG VA
22801-3624
US

V. Phone/Fax

Practice location:
  • Phone: 540-433-5431
  • Fax:
Mailing address:
  • Phone: 540-433-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD A. SIDER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 540-437-4962