Healthcare Provider Details

I. General information

NPI: 1346416500
Provider Name (Legal Business Name): DENTAL CLINIC OF NORTHERN SHENANDOAH VALLEY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N CAMERON ST STE 100
WINCHESTER VA
22601-6018
US

IV. Provider business mailing address

301 N CAMERON ST STE 100
WINCHESTER VA
22601-6018
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-1680
  • Fax:
Mailing address:
  • Phone: 540-536-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RICHARD TALIAFERRO
Title or Position: BOARD CHAIR
Credential: DDS
Phone: 540-869-2600