| NPI | 1801435003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLEY MARIE COYNER Credentialing 304-345-1092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2025-05-30 |