Individual
DR. CYNTHIA MARTIN SOUTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
62 E MAIN STREET, PULASKI, VA 24301
(540) 280-5129
(540) 980-5179
Mailing address
62 E MAIN STREET, PULASKI, VA 24301
(540) 280-5129
(540) 980-5179
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401410201
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9178924
—
VA
Enumeration date
08/21/2006
Last updated
07/08/2007
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