| NPI | 1225149362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE RENEE BOSTIC Business Coordinator 304-645-2333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WV 3268) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |