| Community Dental Care Of Green Bank | |
|
6404 Potomac Highland Trail Green Bank WV 24944-6404 | |
| (304) 456-5433 | |
| (304) 456-5439 |
| Full Name | Community Dental Care Of Green Bank |
|---|---|
| Speciality | Clinic/Center |
| Location | 6404 Potomac Highland Trail, Green Bank, West Virginia |
| Authorized Official Name and Position | Richard G Simon (CEO) |
| Authorized Official Contact | 3049246262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Dental Care Of Green Bank Po Box 85 6404 Potomac Highland Trail Green Bank WV 24944-0085 Ph: (304) 456-5433 | Community Dental Care Of Green Bank 6404 Potomac Highland Trail Green Bank WV 24944-6404 Ph: (304) 456-5433 |
| NPI Number | 1427305911 |
|---|---|
| Provider Enumeration Date | 08/14/2012 |
| Last Update Date | 08/14/2012 |
| Medicare PECOS PAC ID | 0446232987 |
|---|---|
| Medicare Enrollment ID | O20121004000245 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427305911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |