Healthcare Provider Details

I. General information

NPI: 1245237320
Provider Name (Legal Business Name): RODNEY LEE POWERS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A - 3 ROSEMAR CIR BX 4369
PARKERSBURG WV
26104
US

IV. Provider business mailing address

PO BOX 4369
PARKERSBURG WV
26104-4369
US

V. Phone/Fax

Practice location:
  • Phone: 304-428-2058
  • Fax:
Mailing address:
  • Phone: 304-428-2058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberWV2952
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: