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6353 E Pea Ridge Rd Huntington WV 25705-2525 | |
| (304) 736-4794 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6353 E Pea Ridge Rd, Huntington, West Virginia |
| Authorized Official Name and Position | Mark Dake (OWNER) |
| Authorized Official Contact | 5017812777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 3450 Little Rock AR 72203-3450 Ph: (501) 781-2777 | 6353 E Pea Ridge Rd Huntington WV 25705-2525 Ph: (304) 736-4794 |
| NPI Number | 1962933887 |
|---|---|
| Provider Enumeration Date | 03/22/2017 |
| Last Update Date | 03/22/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962933887 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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