| NPI | 1891188801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON MICHAEL MOORE Member 304-424-5355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WV 3424) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2015-03-15 |
| Last Update Date | 2021-04-26 |