| NPI | 1932912631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA PHILLIPS Office Manager 304-263-0991 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2025-01-28 |
| Last Update Date | 2025-01-28 |