# JERRY MOUNTS DDS, INC

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

## Provider details

- **NPI number:** 1285728188
- **Authorized official:** DR. JERRY MOUNTS D.D.S. (PRESIDENT)
- **Authorized official phone:** (304) 426-4161

## Contact information

- **Practice address:** MATE STREET, MATEWAN, WV 25678
- **Practice address phone:** (304) 426-4161
- **Practice address fax:** (304) 426-4162
- **Mailing address:** PO BOX 537, MATEWAN, WV 25678-0537
- **Mailing address phone:** (304) 426-4161
- **Mailing address fax:** (304) 426-4162

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2741 | WV | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0137275000 | — | WV |