Healthcare Provider Details

I. General information

NPI: 1447354675
Provider Name (Legal Business Name): WISE COUNTY DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 ROBERTS AVE SW
WISE VA
24293-5800
US

IV. Provider business mailing address

134 ROBERTS AVE SW
WISE VA
24293-5800
US

V. Phone/Fax

Practice location:
  • Phone: 276-328-8000
  • Fax: 276-376-1020
Mailing address:
  • Phone: 276-328-8000
  • Fax: 276-376-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RODNEY COLLINS
Title or Position: DENTIST
Credential: DMD
Phone: 276-328-8000