Healthcare Provider Details

I. General information

NPI: 1811914799
Provider Name (Legal Business Name): PAUL T. UMSTOTT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 VALLEY ST NW
ABINGDON VA
24210-2728
US

IV. Provider business mailing address

300 VALLEY ST NW
ABINGDON VA
24210-2728
US

V. Phone/Fax

Practice location:
  • Phone: 276-628-1188
  • Fax: 276-628-1203
Mailing address:
  • Phone: 276-628-1188
  • Fax: 276-628-1203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4726
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: