Organization
COMMONWEALTH DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY TODD HARVEY DMD (PRESIDENT)
(540) 685-0028
Entity
Organization
Contact information
Practice address
1121 S JEFFERSON ST, ROANOKE, VA 24016-4703
(540) 685-0028
Mailing address
1618 W MAIN ST, SALEM, VA 24153-3116
(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
12/13/2013
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