| NPI | 1447933700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL LYNN BLANKENSHIP Lead Credentialing Specialst 304-429-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| 261QD0000X Clinic/Center, Dental | |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2023-10-27 |