Organization
KFD VIRGINIA INC
Active
Other names
Kids First Dental
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT HABER ELLIS III DMD (OWNER)
(803) 413-5100
Entity
Organization
Contact information
Practice address
4903 STARKEY RD STE 300, ROANOKE, VA 24018-8525
(540) 904-2700
(540) 904-2760
Mailing address
4903 STARKEY RD STE 300, ROANOKE, VA 24018-8525
(540) 904-2700
(540) 904-2760
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX3691
—
SC
Enumeration date
01/03/2019
Last updated
04/10/2024
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