Organization
TAZEWELL DENTAL SLEEP THERAPY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD WAYNE HOUSEHOLDER D.D.S (OWNER)
(276) 979-5796
Entity
Organization
Contact information
Practice address
316 BEN BOLT AVE, TAZEWELL, VA 24651-9703
(276) 979-5796
(276) 988-5866
Mailing address
125 BEN BOLT AVE, TAZEWELL, VA 24651-9703
(276) 979-5796
(276) 988-5866
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401005792
VA
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
12/12/2012
Last updated
07/21/2022
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