Healthcare Provider Details

I. General information

NPI: 1780331389
Provider Name (Legal Business Name): MALINDA M HUSSON, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MACCORKLE AVE SE STE C
CHARLESTON WV
25304-1835
US

IV. Provider business mailing address

4502 MACCORKLE AVE SE STE C
CHARLESTON WV
25304-1835
US

V. Phone/Fax

Practice location:
  • Phone: 304-926-9260
  • Fax: 304-926-9266
Mailing address:
  • Phone: 304-926-9260
  • Fax: 304-926-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MALINDA M. HUSSON
Title or Position: PEDIATRIC DENTIST/OWNER
Credential: DDS
Phone: 304-926-9260