# COMMONWEALTH DENTAL CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Commonwealth Dental Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144641309
- **Authorized official:** KIM DAVIS (RCM DIRECTOR)
- **Authorized official phone:** (703) 568-5773

## Contact information

- **Practice address:** 1121 S JEFFERSON ST, ROANOKE, VA 24016-4703
- **Practice address phone:** (540) 685-0028
- **Mailing address:** 1121 S JEFFERSON ST, ROANOKE, VA 24016-4703
- **Mailing address phone:** (540) 685-0028

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 0401410880 | VA | Yes |

## Other

- **Enumeration date:** 12/13/2013
- **Last updated:** 08/26/2026