Provider Demographics
NPI:1447354675
Name:WISE COUNTY DENTAL CLINIC
Entity type:Organization
Organization Name:WISE COUNTY DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:276-328-8000
Mailing Address - Street 1:134 ROBERTS AVE SW
Mailing Address - Street 2:
Mailing Address - City:WISE
Mailing Address - State:VA
Mailing Address - Zip Code:24293-5800
Mailing Address - Country:US
Mailing Address - Phone:276-328-8000
Mailing Address - Fax:276-376-1020
Practice Address - Street 1:134 ROBERTS AVE SW
Practice Address - Street 2:
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-5800
Practice Address - Country:US
Practice Address - Phone:276-328-8000
Practice Address - Fax:276-376-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty