| Organization Name: | PIEDMONT DENTAL |
| NPI Number: | 1063811503 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID MICHAEL CLARK (PRESIDENT/OWNER) |
| Mailing Address: | 5205 Courthouse Rd Suite 201 Spotsylvania |
| State: | VA US |
| Postal Code: | 225516390 |
| Phone Number: | 5408957330 |
| Fax Number: | |
| NPI Enumeration Date: | 08/21/2014 |
| NPI Last Update Date: | 08/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 0401411484 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |