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General NPI Number Information
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NPI Number | 1730354374
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN MOBILE DENTAL SERVICES INC
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 18383 N FORK RIVER RD
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City | ABINGDON
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State | VA
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Zip | 24210-4335
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Country | US
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Telephone | 615-202-8864
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Fax |
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Provider Business Mailing Address
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Address Line | 358 RELAX DR # LO2
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City | SMITHVILLE
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State | TN
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Zip | 37166-7351
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Country | US
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Telephone | 615-215-7115
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Fax | 615-215-7113
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Authorized Official
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Title or Position | DENTAL DIRECTOR
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Name | MS. JUDY JONES
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Credential |
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Telephone | 615-202-8864
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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 | VA
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