| NPI | 1629278999 |
|---|---|
| Doing Business As | SOUTH RIVER DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | JEFFERSON T BLACKBURN Dentist 804-378-7888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2007-07-24 |