Provider Demographics
NPI:1396560082
Name:OATH DENTAL LLC
Entity type:Organization
Organization Name:OATH DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-387-3844
Mailing Address - Street 1:101 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-3848
Mailing Address - Country:US
Mailing Address - Phone:540-387-3844
Mailing Address - Fax:
Practice Address - Street 1:101 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-3848
Practice Address - Country:US
Practice Address - Phone:540-387-3844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental