Healthcare Provider Details

I. General information

NPI: 1154642007
Provider Name (Legal Business Name): HEATHER DENISE LINKINOGGOR D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER DENISE GIBSON DDS

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 11/14/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5089 ELK RIVER RD NORTH
ELKVIEW WV
25071
US

IV. Provider business mailing address

PO BOX 9
ELKVIEW WV
25071-0009
US

V. Phone/Fax

Practice location:
  • Phone: 304-965-1200
  • Fax: 304-965-6158
Mailing address:
  • Phone: 304-965-1200
  • Fax: 304-965-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3910
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: