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General NPI Number Information
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NPI Number | 1578076790
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Entity Type | Organization
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Legal Business Name | MILLER & WOLF FAMILY DENTISTRY
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 209 MAIN ST
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City | HURT
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State | VA
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Zip | 24563-3905
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Country | US
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Telephone | 434-324-8241
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Fax | 434-324-8241
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Provider Business Mailing Address
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Address Line | PO BOX 820
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City | HURT
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State | VA
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Zip | 24563-0820
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Country | US
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Telephone | 434-324-8241
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ASHLEY MCBRIDE MATTOX
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Credential |
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Telephone | 434-324-8241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401412826
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License Number State | VA
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