Provider Demographics
NPI:1386714996
Name:APPALACHIAN ORAL & MAXILLOFACIAL SURGERY LTD
Entity type:Organization
Organization Name:APPALACHIAN ORAL & MAXILLOFACIAL SURGERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLLYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:276-783-8131
Mailing Address - Street 1:645 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4223
Mailing Address - Country:US
Mailing Address - Phone:276-783-8131
Mailing Address - Fax:276-783-1839
Practice Address - Street 1:645 PARK BLVD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4223
Practice Address - Country:US
Practice Address - Phone:276-783-8131
Practice Address - Fax:276-783-1839
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPALACHIAN ORAL & MAXILLOFACIAL SURGERY LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014101621223S0112X
VA04014116701223S0112X
VA04010057531223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03349Medicare PIN