Provider Demographics
NPI:1588178479
Name:TUSCARORA DENTISTRY PLLC
Entity Type:Organization
Organization Name:TUSCARORA DENTISTRY PLLC
Other - Org Name:TUSCARORA FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-263-3131
Mailing Address - Street 1:22 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-1133
Mailing Address - Country:US
Mailing Address - Phone:304-263-3131
Mailing Address - Fax:
Practice Address - Street 1:22 SIERRA DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-1133
Practice Address - Country:US
Practice Address - Phone:304-263-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental