Organization
MOUNTAIN KIDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCUS BRANDON BUSKILL DDS (DENTIST)
(276) 988-5583
Entity
Organization
Contact information
Practice address
200 EAST RIVERSIDE DRIVE, NORTH TAZEWELL, VA 24630
(276) 988-5583
(276) 979-1441
Mailing address
PO BOX 1298, 200 EAST RIVERSIDE DRIVE, NORTH TAZEWELL, VA 24630-1298
(276) 988-5583
(276) 979-1441
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401411127
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9182558
—
VA
Enumeration date
08/10/2006
Last updated
08/22/2020
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