| NPI | 1922439462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD MICHAEL BUSH President/Dentist 304-615-4169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 3987) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 2260) |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2013-12-10 |