Healthcare Provider Details

I. General information

NPI: 1063053437
Provider Name (Legal Business Name): HEDGESVILLE DENTAL ARTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N. MARY ST.
HEDGESVILLE WV
25427
US

IV. Provider business mailing address

101 N. MARY ST.
HEDGESVILLE WV
25427
US

V. Phone/Fax

Practice location:
  • Phone: 304-754-8803
  • Fax:
Mailing address:
  • Phone: 304-754-8803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON DAVID SMITH
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 304-754-8803