| NPI | 1730458357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL RICHARD HILLEARY Member 304-296-1721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 3640) |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2011-12-28 |