Impact Family Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

IMPACT FAMILY DENTAL PLLC

Practice address

110 Professional Park Dr SE
Blacksburg, VA 24060-6735

Phone

(540) 655-0170

NPI assigned

Feb 17, 2025

Last updated

Feb 17, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Glenn Evans, DMDNPI 1235511882

Title

Owner

Phone

(540) 655-0170

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Glenn Evans, DMD

  • Dentist
  • Radford, VA
  • NPI 1235511882
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1739750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739750400000",
    "number": "1679378426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 PROFESSIONAL PARK DR SE",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240606735",
            "telephone_number": "540-655-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 PROFESSIONAL PARK DR SE",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240606735",
            "telephone_number": "540-655-0170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT FAMILY DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-17",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-16",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "540-655-0170",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Hurst, PHARMD
• Marilyn K. Hutchins, ED.D.
• Melanie Ann Hux, LAT, ATC
• Michael Chad Hyatt, ATC, EMT
• Ashleigh Iannelli, LPC
• Sara C Inman, LCSW
• Integrated Self Counseling & Supervision, PLLC
• Internal Medicine of Blacksburg LLC
• Sadia Iqbal, DO
• Carissa L Isbell, PHARM. D.

• General Practice Dentistry in Blacksburg, VA
• Providers in Blacksburg, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.