| NPI | 1902026479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDOLPH TERRY EVANS Owner 304-263-3131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WV 2987) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WV 3708) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-08-22 |