Healthcare Provider Details

I. General information

NPI: 1801833629
Provider Name (Legal Business Name): REGINALD S OPIMO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2519 3RD AVE
HUNTINGTON WV
25703-1614
US

IV. Provider business mailing address

2519 3RD AVE
HUNTINGTON WV
25703-1614
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-0560
  • Fax: 304-525-5768
Mailing address:
  • Phone: 304-525-0560
  • Fax: 304-525-5768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3510
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: