Mt State Oral & Maxillofacial Surgeons | |
1215 Virginia St E Charleston WV 25301 | |
(304) 345-1092 | |
(304) 345-5080 |
Full Name | Mt State Oral & Maxillofacial Surgeons |
---|---|
Speciality | Dentist - Oral And Maxillofacial Surgery |
Location | 1215 Virginia St E, Charleston, West Virginia |
Authorized Official Name and Position | Lesley Marie Coyner (CREDENTIALING) |
Authorized Official Contact | 3047207819 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Mt State Oral & Maxillofacial Surgeons 103 Station Place Way Hurricane WV 25526-8747 Ph: (304) 720-7819 | Mt State Oral & Maxillofacial Surgeons 1215 Virginia St E Charleston WV 25301 Ph: (304) 345-1092 |
NPI Number | 1346201183 |
---|---|
Provider Enumeration Date | 03/31/2006 |
Last Update Date | 12/03/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346201183 | NPI | - | NPPES |
000817140 | Other | WV | MT. STATE BCBS |
4500012000 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
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