Organization
BLUE RIDGE FAMILY DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN HANRIDGE DDS (PRESIDENT, BRFD, PC)
(928) 367-4466
Entity
Organization
Contact information
Practice address
1450 E WHITE MOUNTAIN BLVD STE A, PINETOP, AZ 85935-7091
(928) 367-4466
Mailing address
PO BOX 3768, PINETOP, AZ 85935-3768
(928) 367-4466
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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