# LADYSMITH DENTAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LADYSMITH DENTAL CENTER
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1912346073
- **Legal business name:** LADYSMITH DENTAL CENTER
- **Authorized official:** KELLY LYNN ROTHENBERGER (OFFICE MANAGER)
- **Authorized official phone:** (804) 589-1491

## Contact information

- **Practice address:** 18010 JEFFERSON DAVIS HWY, RUTHER GLEN, VA 22546-2922
- **Practice address phone:** (804) 589-1491
- **Practice address fax:** (804) 589-1494
- **Mailing address:** 18010 JEFFERSON DAVIS HWY, RUTHER GLEN, VA 22546-2922
- **Mailing address phone:** (804) 589-1491
- **Mailing address fax:** (804) 589-1494

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 0401412257 | VA | Yes |

## Other

- **Enumeration date:** 06/21/2013
- **Last updated:** 06/21/2013