Real Life Seventeen

NPI #1831680172 in Blacksburg, Virginia

Provider Information

NPI Number: 1831680172
Entity Type: Organization
Organization Name: Real Life Seventeen
Primary Specialty: Dentist - Orthodontics and Dentofacial Orthopedics
Enumeration Date: May 22, 2018
Last Updated: May 22, 2018

Practice Location

Address: 202 S MAIN ST STE 101
City: Blacksburg
State: Virginia
ZIP Code: 24060-4837
Phone: (540) 443-9285

Authorized Official

Name: DAMON B THOMPSON, DDS
Title: OWNER
Phone: (540) 552-5433

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Orthodontics and Dentofacial Orthopedics — Orthodontics and Dentofacial Orthopedics	1223X0400X	Primary

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