| NPI | 1134284714 |
|---|---|
| Doing Business As | FAMILY DENTAL PRACTICE INC |
| Entity Type | Organization |
| Authorized Contact | ROBERT A MONTGOMERY Dentist Manager Secretary 304-636-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WV WV2960) |
| Additional Taxonomies | 122300000X Dentist |
| 122300000X Dentist (Licence: WV W3576) | |
| 122300000X Dentist (Licence: WV WV2192) | |
| 122300000X Dentist (Licence: WV WV3367) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2020-08-22 |