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Organization
COMMONWEALTH DENTAL CLINIC INC
Active
Organization
COMMONWEALTH DENTAL CLINIC INC
Active
Other names
Commonwealth Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KIM DAVIS (RCM DIRECTOR)
(703) 568-5773
Entity
Organization
Contact information
Practice address
1121 S JEFFERSON ST, ROANOKE, VA 24016-4703
(540) 685-0028
Mailing address
1121 S JEFFERSON ST, ROANOKE, VA 24016-4703
(540) 685-0028
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
0401410880
VA
Other
Enumeration date
12/13/2013
Last updated
08/26/2026
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