Provider Demographics
NPI:1164238259
Name:LYNCHBURG PERIODONTICS PLLC
Entity type:Organization
Organization Name:LYNCHBURG PERIODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-455-2444
Mailing Address - Street 1:525 LEESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2328
Mailing Address - Country:US
Mailing Address - Phone:434-455-2444
Mailing Address - Fax:434-237-2050
Practice Address - Street 1:525 LEESVILLE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2328
Practice Address - Country:US
Practice Address - Phone:434-455-2444
Practice Address - Fax:434-237-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1912578626OtherPERIODONTIST
VA1942349329OtherPERIODONTIST