Provider Demographics
NPI:1205475092
Name:BLAND MINISTRY CENTER AND DENTAL CLINIC
Entity type:Organization
Organization Name:BLAND MINISTRY CENTER AND DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:ADRENA
Authorized Official - Last Name:PARRIS-WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:276-228-4711
Mailing Address - Street 1:65 SEDDON STREET
Mailing Address - Street 2:PO BOX 211
Mailing Address - City:BLAND
Mailing Address - State:VA
Mailing Address - Zip Code:24315
Mailing Address - Country:US
Mailing Address - Phone:276-688-4701
Mailing Address - Fax:276-688-4700
Practice Address - Street 1:435 W NORTH ST
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2246
Practice Address - Country:US
Practice Address - Phone:276-228-4711
Practice Address - Fax:276-228-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty