Provider Demographics
NPI:1639785934
Name:MISSION DENTAL VIRGINIA, INC
Entity Type:Organization
Organization Name:MISSION DENTAL VIRGINIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTISTS
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:276-466-9800
Mailing Address - Street 1:616 CAMPUS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-9706
Mailing Address - Country:US
Mailing Address - Phone:276-525-4487
Mailing Address - Fax:
Practice Address - Street 1:616 CAMPUS DR STE 100
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9706
Practice Address - Country:US
Practice Address - Phone:276-525-4487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty