Healthcare Provider Details

I. General information

NPI: 1124129937
Provider Name (Legal Business Name): SOKOLOSKY AND WEAVER DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 OAKWOOD RD
CHARLESTON WV
25314-2057
US

IV. Provider business mailing address

869 OAKWOOD RD
CHARLESTON WV
25314-2057
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-5161
  • Fax: 304-343-5205
Mailing address:
  • Phone: 304-343-5161
  • Fax: 304-343-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2578-78
License Number StateWV

VIII. Authorized Official

Name: DR. MICHAEL SOKOLOSKY JR.
Title or Position: PRESIDENT
Credential: DDS
Phone: 304-343-5161