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General NPI Number Information
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NPI Number | 1205475092
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Entity Type | Organization
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Legal Business Name | BLAND MINISTRY CENTER AND DENTAL CLINIC
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Dates
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Enumeration Date | 12/27/2019
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 435 W NORTH ST
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City | WYTHEVILLE
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State | VA
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Zip | 24382-2246
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Country | US
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Telephone | 276-228-4711
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Fax | 276-228-4712
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Provider Business Mailing Address
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Address Line | 65 SEDDON STREET PO BOX 211
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City | BLAND
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State | VA
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Zip | 24315
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Country | US
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Telephone | 276-688-4701
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Fax | 276-688-4700
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Authorized Official
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Title or Position | DENTAL DIRECTOR
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Name | DR. TONYA ADRENA PARRIS-WILKINS
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Credential | DDS
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Telephone | 276-228-4711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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