| NPI | 1578936514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES A SPADAFORE President 304-233-1180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WV 3035) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2015-11-12 |