| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 22 Fleming Dr, Harts, West Virginia |
| Authorized Official Name and Position | Richard Weinberger (CFO) |
| Authorized Official Contact | 3045253334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1680 Huntington WV 25717-1680 Ph: (304) 697-1396 | 22 Fleming Dr Harts WV 25524-9788 Ph: (304) 855-4595 |
| NPI Number | 1518299825 |
|---|---|
| Provider Enumeration Date | 02/11/2010 |
| Last Update Date | 01/12/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518299825 | NPI | - | NPPES |
| 3810017440 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3263 (West Virginia) | Primary |