Mountain Kids, Inc.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401411127 Issued in VA

Legal business name

MOUNTAIN KIDS, INC.

Practice address

200 East Riverside Drive
North Tazewell, VA 24630

Phone

(276) 988-5583

Fax

(276) 979-1441

NPI assigned

Aug 10, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marcus Brandon Buskill, DDS

Title

Dentist

Phone

(276) 988-5583

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235140716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1298",
            "address_2": "200 EAST RIVERSIDE DRIVE",
            "city": "NORTH TAZEWELL",
            "state": "VA",
            "postal_code": "246301298",
            "telephone_number": "276-988-5583",
            "fax_number": "276-979-1441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 EAST RIVERSIDE DRIVE",
            "city": "NORTH TAZEWELL",
            "state": "VA",
            "postal_code": "24630",
            "telephone_number": "276-988-5583",
            "fax_number": "276-979-1441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN KIDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUSKILL",
        "authorized_official_first_name": "MARCUS",
        "authorized_official_middle_name": "BRANDON",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "276-988-5583",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401411127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9182558",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in North Tazewell, VA
• Providers in North Tazewell, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.