| NPI | 1669508776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY MICHAEL CROW President 304-748-4210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WV 3670) |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2014-08-11 |