Provider Demographics
NPI:1770517005
Name:RODNEY L. POWERS, DDS, INC.
Entity type:Organization
Organization Name:RODNEY L. POWERS, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-428-2058
Mailing Address - Street 1:3 ROSEMAR CIRCLE, SUITE A
Mailing Address - Street 2:PO BOX 4369
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 1:3 ROSEMAR CIRCLE, SUITE A
Practice Address - Street 2:BOX 4369
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-4369
Practice Address - Country:US
Practice Address - Phone:304-428-2058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2952261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV89316447OtherTPIN CCR FED. GOV.
WVWV 2952OtherLICEN.
WV1245237320OtherTYPE I NPI
WV0133093-000Medicaid
WV89316447OtherTPIN CCR FED. GOV.