| Children's Dentistry | |
|
1400 Kanawha Blvd E Charleston WV 25301-3002 | |
| (304) 345-0541 | |
| (304) 345-8718 |
| Full Name | Children's Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 1400 Kanawha Blvd E, Charleston, West Virginia |
| Authorized Official Name and Position | Tracy Lynn Wilkerson (PEDIATRIC SPECIALIST) |
| Authorized Official Contact | 3043450541 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Children's Dentistry 1400 Kanawha Blvd E Charleston WV 25301-3002 Ph: (304) 345-0541 | Children's Dentistry 1400 Kanawha Blvd E Charleston WV 25301-3002 Ph: (304) 345-0541 |
| NPI Number | 1760501001 |
|---|---|
| Provider Enumeration Date | 03/28/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760501001 | NPI | - | NPPES |
| 1528024460 | Other | WV | INDIVIDUAL NPI |
| 4005111000 | Medicaid | WV | |
| 3810005586 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 3529 (West Virginia) | Primary |
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