| NPI | 1831784883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTOPHER REYNOLDS Owner 304-250-1214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2022-02-11 |