Organization
JERRY MOUNTS DDS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY MOUNTS D.D.S. (PRESIDENT)
(304) 426-4161
Entity
Organization
Contact information
Practice address
MATE STREET, MATEWAN, WV 25678
(304) 426-4161
(304) 426-4162
Mailing address
PO BOX 537, MATEWAN, WV 25678-0537
(304) 426-4161
(304) 426-4162
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2741
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0137275000
—
WV
Enumeration date
10/03/2006
Last updated
08/22/2020
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