| NPI | 1033131537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON M. ROUSH President 304-420-9022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 3396) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2008-12-02 |