| Mountain Kids, Inc. | |
|
200 East Riverside Drive North Tazewell VA 24630 | |
| (276) 988-5583 | |
| (276) 979-1441 |
| Full Name | Mountain Kids, Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 200 East Riverside Drive, North Tazewell, Virginia |
| Authorized Official Name and Position | Marcus Brandon Buskill (DENTIST) |
| Authorized Official Contact | 2769885583 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Kids, Inc. Po Box 1298 200 East Riverside Drive North Tazewell VA 24630-1298 Ph: (276) 988-5583 | Mountain Kids, Inc. 200 East Riverside Drive North Tazewell VA 24630 Ph: (276) 988-5583 |
| NPI Number | 1235140716 |
|---|---|
| Provider Enumeration Date | 08/10/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235140716 | NPI | - | NPPES |
| 9182558 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 0401411127 (Virginia) | Primary |