| NPI | 1124106273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WILSON SIMPSON Owner 304-342-6162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 001) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2022-07-21 |