| NPI | 1124120175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ANDREW JOSEPH Member 304-522-6050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: WV 3478DENTAL23PERIODON) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2020-08-22 |