Provider Demographics
NPI:1811914799
Name:UMSTOTT, PAUL T (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:UMSTOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 VALLEY ST NW
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2728
Mailing Address - Country:US
Mailing Address - Phone:276-628-1188
Mailing Address - Fax:276-628-1203
Practice Address - Street 1:300 VALLEY ST NW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2728
Practice Address - Country:US
Practice Address - Phone:276-628-1188
Practice Address - Fax:276-628-1203
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA47261223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA017995OtherANTHEM
VA44722OtherUNITED CONCORDIA
VA9178757Medicaid
TN0066411OtherBCBST