Healthcare Provider Details

I. General information

NPI: 1235243148
Provider Name (Legal Business Name): RICHARD LEE TALIAFERRO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 WARRIOR DRIVE
STEPHENS CITY VA
22655
US

IV. Provider business mailing address

PO BOX 819
STEPHENS CITY VA
22655-0819
US

V. Phone/Fax

Practice location:
  • Phone: 540-869-2600
  • Fax: 540-869-7948
Mailing address:
  • Phone: 540-869-2600
  • Fax: 540-869-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401006221
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: