Mt State Oral & Facial Surgery | |
4307 Maccorkle Ave Se Charleston WV 25304-2500 | |
(304) 345-1092 | |
Not Available |
Full Name | Mt State Oral & Facial Surgery |
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Speciality | Dentist - Oral And Maxillofacial Surgery |
Location | 4307 Maccorkle Ave Se, Charleston, West Virginia |
Authorized Official Name and Position | Lesley Marie Coyner (CREDENTIALING) |
Authorized Official Contact | 3043451092 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Mt State Oral & Facial Surgery 103 Station Place Way Hurricane WV 25526-8747 Ph: (304) 720-7819 | Mt State Oral & Facial Surgery 4307 Maccorkle Ave Se Charleston WV 25304-2500 Ph: (304) 345-1092 |
NPI Number | 1447711858 |
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Provider Enumeration Date | 03/28/2019 |
Last Update Date | 12/03/2020 |
Identifier | Type | State | Issuer |
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1447711858 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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