Provider Demographics
NPI:1306343868
Name:DANVILLE DENTAL ASSOCIATES, PC
Entity type:Organization
Organization Name:DANVILLE DENTAL ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-822-1332
Mailing Address - Street 1:5011 RIVERSIDE DR STE B
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-5642
Mailing Address - Country:US
Mailing Address - Phone:434-822-1332
Mailing Address - Fax:434-822-1336
Practice Address - Street 1:5011 RIVERSIDE DR STE B
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-5642
Practice Address - Country:US
Practice Address - Phone:434-822-1332
Practice Address - Fax:434-822-1336
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANVILLE DENTAL ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-11
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014107251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1770583106OtherNPI