Healthcare Provider Details

I. General information

NPI: 1588926885
Provider Name (Legal Business Name): ROCKBRIDGE REGIONAL DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NORTHRIDGE LN
LEXINGTON VA
24450-3399
US

IV. Provider business mailing address

25 NORTHRIDGE LN
LEXINGTON VA
24450-3399
US

V. Phone/Fax

Practice location:
  • Phone: 540-464-8700
  • Fax: 540-464-1362
Mailing address:
  • Phone: 540-464-8700
  • Fax: 540-464-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE SHERIDAN
Title or Position: DIRECTOR
Credential:
Phone: 540-464-8700