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General NPI Number Information
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NPI Number | 1285457879
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Entity Type | Organization
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Legal Business Name | REAL LIFE DENTAL OF CHRISTIANSBURG, PLLC
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 100 QUIN W STUART BLVD NW
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073
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Country | US
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Telephone | 540-418-6050
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Fax |
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Provider Business Mailing Address
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Address Line | 100 QUIN W STUART BLVD NW
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City | CHRISTIANSBURG
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State | VA
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Zip | 24073
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DAMON THOMPSON
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Credential |
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Telephone | 540-552-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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