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General NPI Number Information
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NPI Number | 1639785934
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Entity Type | Organization
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Legal Business Name | MISSION DENTAL VIRGINIA, INC
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 616 CAMPUS DR STE 100
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City | ABINGDON
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State | VA
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Zip | 24210-9706
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Country | US
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Telephone | 276-525-4487
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Fax |
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Provider Business Mailing Address
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Address Line | 616 CAMPUS DR STE 100
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City | ABINGDON
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State | VA
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Zip | 24210-9706
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Country | US
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Telephone | 276-525-4487
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Fax |
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Authorized Official
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Title or Position | PROSTHODONTISTS
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Name | DR. SCOTT MILLER
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Credential | DDS
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Telephone | 276-466-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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