Healthcare Provider Details

I. General information

NPI: 1083802607
Provider Name (Legal Business Name): E. ROSS TESTERMAN,JR.,D.D.S.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N COALTER ST
STAUNTON VA
24401-3401
US

IV. Provider business mailing address

504 N COALTER ST
STAUNTON VA
24401-3401
US

V. Phone/Fax

Practice location:
  • Phone: 540-885-1631
  • Fax: 540-885-7015
Mailing address:
  • Phone: 540-885-1631
  • Fax: 540-885-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number0401005809
License Number StateVA

VIII. Authorized Official

Name: DR. EDWARD ROSS TESTERMAN JR.
Title or Position: DENTIST
Credential: DDS
Phone: 540-885-1631