| NPI | 1366000259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNNEL BEAUCHESNE Primary Owner 304-290-1997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2019-06-05 |