Provider Demographics
NPI:1306290937
Name:WILLIAMSON ROAD DENTAL, LLC
Entity type:Organization
Organization Name:WILLIAMSON ROAD DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NARDEA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-859-3353
Mailing Address - Street 1:12 ALVORD ST
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1152
Mailing Address - Country:US
Mailing Address - Phone:732-859-3353
Mailing Address - Fax:732-222-1149
Practice Address - Street 1:1502 WILLIAMSON RD NE
Practice Address - Street 2:SUITE C
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-5130
Practice Address - Country:US
Practice Address - Phone:540-339-9338
Practice Address - Fax:540-400-0525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMPLY STRAIGHT, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty