| NPI | 1841693355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE L. JOHNSON Clinical Practice Manager 304-514-5500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 2081) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2022-08-05 |