| NPI | 1801032073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITRI ALBERTO GHAREEB Officer 304-727-2222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 3713) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 3725) |
| 1223G0001X Dentist, General Practice (Licence: WV 3619) | |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2008-12-18 |