Healthcare Provider Details

I. General information

NPI: 1649849340
Provider Name (Legal Business Name): KATHERINE WOOTON D.D.S., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 PROFESSIONAL PARK DR STE 100
SUMMERSVILLE WV
26651-2033
US

IV. Provider business mailing address

702 PROFESSIONAL PARK DR STE 100
SUMMERSVILLE WV
26651-2033
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-7272
  • Fax:
Mailing address:
  • Phone: 304-872-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHERINE WOOTON
Title or Position: DENTIST
Credential:
Phone: 304-692-6112