| Dental Office - Medicaid | |
|
186 Hospital Drive Grantsville WV 26147-7100 | |
| (304) 354-9244 | |
| (304) 354-9323 |
| Full Name | Dental Office - Medicaid |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 186 Hospital Drive, Grantsville, West Virginia |
| Authorized Official Name and Position | Stephen S. Whited (CFO/COO) |
| Authorized Official Contact | 3043549244 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dental Office - Medicaid 186 Hospital Drive Grantsville WV 26147-7100 Ph: (304) 354-9244 | Dental Office - Medicaid 186 Hospital Drive Grantsville WV 26147-7100 Ph: (304) 354-9244 |
| NPI Number | 1962519967 |
|---|---|
| Provider Enumeration Date | 08/24/2006 |
| Last Update Date | 04/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962519967 | NPI | - | NPPES |
| 0002176-008 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 150 (West Virginia) | Primary |
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