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General NPI Number Information
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NPI Number | 1104831635
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Entity Type | Organization
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Legal Business Name | CENTRAL VIRGINIA FAMILY DENTISTRY
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 07/22/2008
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Provider Practice Location Address
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Address Line | 20936 TIMBERLAKE RD SUITE A
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City | LYNCHBURG
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State | VA
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Zip | 24502
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Country | US
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Telephone | 434-237-0004
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Fax | 434-237-6597
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Provider Business Mailing Address
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Address Line | 20936 TIMBERLAKE RD SUITE A
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City | LYNCHBURG
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State | VA
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Zip | 24502
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Country | US
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Telephone | 434-237-0004
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Fax | 434-237-6597
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SHANE R CLAIRBORNE
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Credential | DDS
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Telephone | 434-237-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401410751
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401410958
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401005086
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License Number State | VA
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