| NPI | 1467800417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON WILSON Owner 304-594-9005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 3565) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 3574) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2016-06-01 |