Provider Demographics
NPI:1245237320
Name:POWERS, RODNEY LEE (DDS)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:LEE
Last Name:POWERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4369
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-4369
Mailing Address - Country:US
Mailing Address - Phone:304-428-2058
Mailing Address - Fax:
Practice Address - Street 1:A - 3 ROSEMAR CIR
Practice Address - Street 2:BX 4369
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104
Practice Address - Country:US
Practice Address - Phone:304-428-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV29521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0133093-000Medicaid