Healthcare Provider Details

I. General information

NPI: 1023466513
Provider Name (Legal Business Name): SHENANDOAH ORAL AND FACIAL SURGERY, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 LEGACY LANE
ROCKINGHAM VA
22801-5431
US

IV. Provider business mailing address

2031 LEGACY LANE
ROCKINGHAM VA
22801-5431
US

V. Phone/Fax

Practice location:
  • Phone: 540-433-1751
  • Fax: 540-433-1756
Mailing address:
  • Phone: 540-433-1751
  • Fax: 540-433-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401415056
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number0438000361
License Number StateVA

VIII. Authorized Official

Name: DR. AARON EUGENE QUITMEYER
Title or Position: OWNER/CEO
Credential: D.D.S.
Phone: 540-433-1751