Organization
REAL LIFE SEVENTEEN
Active
Other names
Real Life Smiles
Organization subpart
No
Provider details
NPI number
Authorized official
DAMON B THOMPSON DDS (OWNER)
(540) 552-5433
Entity
Organization
Contact information
Practice address
202 S MAIN ST STE 101, BLACKSBURG, VA 24060-4837
(540) 443-9285
Mailing address
250 S MAIN ST STE 300A, BLACKSBURG, VA 24060-4726
(540) 552-5433
(540) 552-2273
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
401415504
VA
Other
Enumeration date
05/22/2018
Last updated
05/22/2018
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