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General NPI Number Information
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NPI Number | 1063811503
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Entity Type | Organization
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Legal Business Name | PIEDMONT DENTAL
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Dates
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Enumeration Date | 08/21/2014
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 5205 COURTHOUSE RD SUITE 201
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City | SPOTSYLVANIA
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State | VA
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Zip | 22551-6390
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Country | US
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Telephone | 540-895-7330
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Fax |
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Provider Business Mailing Address
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Address Line | 5205 COURTHOUSE RD SUITE 201
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City | SPOTSYLVANIA
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State | VA
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Zip | 22551-6390
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Country | US
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Telephone | 540-895-7330
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. DAVID MICHAEL CLARK
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Credential | DDS
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Telephone | 540-895-7330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401411484
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License Number State | VA
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