Provider Demographics
NPI:1912011362
Name:MIMS AND WOODS DENTISTRY PARTNERSHIP
Entity Type:Organization
Organization Name:MIMS AND WOODS DENTISTRY PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MIMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD,FAGD
Authorized Official - Phone:828-837-3577
Mailing Address - Street 1:96 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-2949
Mailing Address - Country:US
Mailing Address - Phone:828-837-3577
Mailing Address - Fax:828-837-0922
Practice Address - Street 1:96 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-2949
Practice Address - Country:US
Practice Address - Phone:828-837-3577
Practice Address - Fax:828-837-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5614/69381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty