| Organization Name: | STAUNTON CITY DENTAL CLINIC |
| NPI Number: | 1083719421 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CAMERON M HEYDARI (DENTIST) |
| Mailing Address: | 1414 N Augusta St Staunton |
| State: | VA US |
| Postal Code: | 22402 |
| Phone Number: | 5403327830 |
| Fax Number: | 5408850149 |
| NPI Enumeration Date: | 09/13/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | 0401410833 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |