| NPI | 1710518543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRSTAL KAY THOMPSON President 304-731-6688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2020-01-30 |