| NPI | 1043329402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE ERIC BRUM President 304-428-1151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WV 2616) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2016-04-27 |