Healthcare Provider Details

I. General information

NPI: 1700243250
Provider Name (Legal Business Name): RICHARD L. TALIAFERRO DDS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 WARRIOR DR
STEPHENS CITY VA
22655-4045
US

IV. Provider business mailing address

304 LONGVIEW LN
WINCHESTER VA
22602-2880
US

V. Phone/Fax

Practice location:
  • Phone: 540-869-2600
  • Fax: 540-869-7948
Mailing address:
  • Phone: 540-722-3157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0401006221
License Number StateVA

VIII. Authorized Official

Name: DR. RICHARD LEE TALIAFERRO
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 540-722-3157