Provider Demographics
NPI:1447699277
Name:CROZET PEDIATRIC DENTISTRY, PC
Entity type:Organization
Organization Name:CROZET PEDIATRIC DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-387-2423
Mailing Address - Street 1:1005 HEATHERCROFT CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-3369
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 CLAREMONT LANE
Practice Address - Street 2:SUITE 101
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3369
Practice Address - Country:US
Practice Address - Phone:434-205-4594
Practice Address - Fax:434-205-4627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty