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General NPI Number Information
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NPI Number | 1881107100
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Entity Type | Organization
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Legal Business Name | NEW RIVER PERIODONTICS AND DENTAL IMPLANT CENTER, PC
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 11/08/2017
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Provider Practice Location Address
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Address Line | 2612 SHEFFIELD DRIVE
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City | BLACKSBURG
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State | VA
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Zip | 24060
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Country | US
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Telephone | 540-951-4848
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Fax | 540-951-0874
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Provider Business Mailing Address
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Address Line | 2612 SHEFFIELD DRIVE
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City | BLACKSBURG
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State | VA
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Zip | 24060
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Country | US
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Telephone | 540-951-4848
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Fax | 540-951-0874
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Authorized Official
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Title or Position | OWNER/PERIODONTIST
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Name | DR. JOHN JOSEPH BUYER JR.
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Credential | D.D.S.
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Telephone | 540-951-4848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 0401006718
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License Number State | VA
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