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General NPI Number Information
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NPI Number | 1447699277
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Entity Type | Organization
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Legal Business Name | CROZET PEDIATRIC DENTISTRY, PC
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Dates
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Enumeration Date | 06/14/2013
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 300 CLAREMONT LANE SUITE 101
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City | CROZET
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State | VA
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Zip | 22932-3369
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Country | US
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Telephone | 434-205-4594
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Fax | 434-205-4627
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Provider Business Mailing Address
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Address Line | 1005 HEATHERCROFT CIR STE 300
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City | CROZET
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State | VA
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Zip | 22932-3369
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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 | PRESIDENT/PEDIATRIC DENTIST
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Name | DR. KEVIN CLIFFORD
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Credential | DDS
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Telephone | 804-387-2423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 0401411881
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License Number State | VA
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