| NPI | 1134890833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL LYNN BLANKENSHIP Credentialing Manager 304-710-9144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 122300000X Dentist |
| 251S00000X | |
| 261QD0000X Clinic/Center, Dental | |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2024-09-02 |