Full Name | |
---|---|
Speciality | Dentist - General Practice |
Location | 178 Main St., Poca, West Virginia |
Authorized Official Name and Position | Ricky Boggess (BUSINESS MANAGER) |
Authorized Official Contact | 3047577441 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 566 Poca WV 25159-0566 Ph: (304) 755-3931 | 178 Main St. Poca WV 25159 Ph: (304) 755-3931 |
NPI Number | 1437371713 |
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Provider Enumeration Date | 05/03/2007 |
Last Update Date | 01/21/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1437371713 | NPI | - | NPPES |
1780791061 | Other | WV | INDIVIDUAL NPI # |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 2118 (West Virginia) | Primary |