Healthcare Provider Details

I. General information

NPI: 1043502198
Provider Name (Legal Business Name): SCOTTSVILLE FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 VALLEY ST
SCOTTSVILLE VA
24590-4983
US

IV. Provider business mailing address

PO BOX 667
SCOTTSVILLE VA
24590-0667
US

V. Phone/Fax

Practice location:
  • Phone: 434-286-3326
  • Fax: 434-286-2973
Mailing address:
  • Phone: 434-286-3326
  • Fax: 434-286-2973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401008213
License Number StateVA

VIII. Authorized Official

Name: DR. RICHARD HENRY BAIER
Title or Position: D.D.S.
Credential:
Phone: 434-286-3326