Healthcare Provider Details

I. General information

NPI: 1447364278
Provider Name (Legal Business Name): STEPHENS CITY FAMILY DENTISTRY, P.C,.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2020
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 Number0568367-7
License Number StateVA

VIII. Authorized Official

Name: DR. RICHARD LEE TALIAFERRO
Title or Position: SECRETARY/TREASURER
Credential: D.D.S.
Phone: 540-869-2600