| NPI | 1639376148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN ALAN BOYLES Orthodontist 304-363-8530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WV WV3008) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2020-08-22 |