| NPI | 1649794348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA E MOSS Office Manager 304-343-1216 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WV 2097) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2022-07-21 |