# RUSSELL COUNTY DENTAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265544332
- **Authorized official:** REISA SLOCE (COO)
- **Authorized official phone:** (276) 889-7621

## Contact information

- **Practice address:** 133 HIGHLAND DR STE A, LEBANON, VA 24266-7209
- **Practice address phone:** (276) 889-7621
- **Practice address fax:** (276) 889-7695
- **Mailing address:** PO BOX 2347, LEBANON, VA 24266-2347
- **Mailing address phone:** (276) 889-7621
- **Mailing address fax:** (276) 889-7695

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 09/14/2022