| NPI | 1609973825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN T MOORE General Dentist 304-343-7121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 2902) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 2921) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-08-22 |