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NPI Code Detail

MEDICARE: MISSION DENTAL VIRGINIA, INC

MEDICARE: MISSION DENTAL VIRGINIA, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1639785934
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSION DENTAL VIRGINIA, INC
Provider Business Mailing Address
First Line : 616 CAMPUS DR STE 100
Second Line :
City : ABINGDON
State : VA
Zip : 24210-9706
Country : US
Telephone Number : 276-525-4487
Fax Number :
Provider Business Practice Location Address
First Line : 616 CAMPUS DR STE 100
Second Line :
City : ABINGDON
State : VA
Zip : 24210-9706
Country : US
Telephone Number : 276-525-4487
Fax Number :
Authorized Official
Title or Position : PROSTHODONTISTS
Name : DR. SCOTT MILLER
Credential : DDS
Telephone Number : 276-466-9800
Provider Enumeration Date : 09/22/2020
Last Update Date : 09/22/2020

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Directions to “MISSION DENTAL VIRGINIA, INC ” Practice Location

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