| NPI | 1811041171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANNA S. PEYTON Receptionist 304-267-3928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WV 2742) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2008-08-28 |