MEDICARE: KATHERINE WOOTON D.D.S., INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center
2	122300000X	Dentist

General Provider Information

NPI Number	:	1649849340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHERINE WOOTON D.D.S., INC

Provider Business Mailing Address
First Line	:	702 PROFESSIONAL PARK DR STE 100
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-2033
Country	:	US
Telephone Number	:	304-872-7272
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 PROFESSIONAL PARK DR STE 100
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-2033
Country	:	US
Telephone Number	:	304-872-7272
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. KATHERINE WOOTON
Credential	:
Telephone Number	:	304-692-6112

Provider Enumeration Date	:	06/18/2021
Last Update Date	:	06/18/2021

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