Provider Demographics
NPI:1649849340
Name:KATHERINE WOOTON D.D.S., INC
Entity type:Organization
Organization Name:KATHERINE WOOTON D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-692-6112
Mailing Address - Street 1:702 PROFESSIONAL PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-2033
Mailing Address - Country:US
Mailing Address - Phone:304-872-7272
Mailing Address - Fax:
Practice Address - Street 1:702 PROFESSIONAL PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-2033
Practice Address - Country:US
Practice Address - Phone:304-872-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty