| NPI | 1831123850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL A. GILLEY Owner/President 304-425-2978 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 2854) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2013-05-29 |