Healthcare Provider Details

I. General information

NPI: 1114225091
Provider Name (Legal Business Name): PIEDMONT REGIONAL DENTAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13296 JAMES MADISON HWY
ORANGE VA
22960-2810
US

IV. Provider business mailing address

PO BOX 151
ORANGE VA
22960-0087
US

V. Phone/Fax

Practice location:
  • Phone: 540-661-0008
  • Fax:
Mailing address:
  • Phone: 540-661-0008
  • 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: MR. ANDRE HINTERMANN
Title or Position: PRESIDENT, BOARD OF DIRECTORS
Credential:
Phone: 540-661-0008