| NPI | 1407397516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAH RAE HAIRSTON Owner Dentist 304-542-7860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV WV4152) |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2017-03-09 |