Provider Demographics
NPI:1114198132
Name:NATHAN SCOTT HOUCHINS P.C.
Entity Type:Organization
Organization Name:NATHAN SCOTT HOUCHINS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HOUCHINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:276-223-0006
Mailing Address - Street 1:190 TAZEWELL STREET
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382
Mailing Address - Country:US
Mailing Address - Phone:276-223-0006
Mailing Address - Fax:276-223-0008
Practice Address - Street 1:190 TAZEWELL STREET
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382
Practice Address - Country:US
Practice Address - Phone:276-223-0006
Practice Address - Fax:276-223-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9203583Medicaid