| NPI | 1356536593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELLA HURST Ofc. Mngr. 304-425-2611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 03440) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 1880) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2023-09-06 |