| NPI | 1710344742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACY KISH Office Manager 304-366-0088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 3706) |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2016-01-21 |