| NPI | 1649849340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHERINE WOOTON Dentist 304-692-6112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2021-06-18 |