| NPI | 1992284335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE COFFEY Office Manager 304-263-0411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: WV 3624) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2018-08-07 |