| NPI | 1871025429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IMAD SHAMMAA Owner 304-925-4258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WV 3192) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2017-05-02 |