| NPI | 1235544958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOCELYN NICOLE VILAIN Office Manager 304-622-4828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WV 3781) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2016-02-03 |