| NPI | 1710067269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MATTHEW MATHIAS Vice President Dentist 304-267-8702 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WV wv 1794) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2020-08-22 |