# MOUNTAIN KIDS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235140716
- **Authorized official:** DR. MARCUS BRANDON BUSKILL DDS (DENTIST)
- **Authorized official phone:** (276) 988-5583

## Contact information

- **Practice address:** 200 EAST RIVERSIDE DRIVE, NORTH TAZEWELL, VA 24630
- **Practice address phone:** (276) 988-5583
- **Practice address fax:** (276) 979-1441
- **Mailing address:** PO BOX 1298, 200 EAST RIVERSIDE DRIVE, NORTH TAZEWELL, VA 24630-1298
- **Mailing address phone:** (276) 988-5583
- **Mailing address fax:** (276) 979-1441

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 0401411127 | VA | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 9182558 | — | VA |