| NPI | 1033132402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JO DONAHUE Office Manager 304-242-0641 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: WV 2039) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2007-08-31 |