# BASS & KAMP SOUTH MAIN LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** New River Dental Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306486840
- **Authorized official:** DR. JUSTIN NEIL TEBBENKAMP DDS (MEMBER)
- **Authorized official phone:** (540) 838-5050

## Contact information

- **Practice address:** 210 PROFESSIONAL PARK DR SE STE 11, BLACKSBURG, VA 24060-6649
- **Practice address phone:** (540) 951-3989
- **Mailing address:** 210 PROFESSIONAL PARK DR SE STE 11, BLACKSBURG, VA 24060-6649

## Taxonomy

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

## Other

- **Enumeration date:** 01/13/2020
- **Last updated:** 01/13/2020