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 |