| NPI | 1992698153 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERYL LYNN BURR Administration Front Office 304-623-9188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2025-05-29 |
| Last Update Date | 2025-06-04 |