| NPI | 1235024720 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLEY COYNER Director Of Revenue 304-720-7819 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2025-06-12 |
| Last Update Date | 2025-06-12 |