Provider Demographics
NPI:1730225350
Name:PIEDMONT VIRGINIA DENTAL HEALTH FOUNDATION
Entity type:Organization
Organization Name:PIEDMONT VIRGINIA DENTAL HEALTH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:276-632-9266
Mailing Address - Street 1:407 STARLING AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3731
Mailing Address - Country:US
Mailing Address - Phone:276-632-9266
Mailing Address - Fax:
Practice Address - Street 1:23 FAYETTE STREET
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112
Practice Address - Country:US
Practice Address - Phone:276-632-7727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental