| NPI | 1356725428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDOLPH EVANS Dentist/Owner 304-263-3131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WV 4175) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2015-07-17 |