Healthcare Provider Details

I. General information

NPI: 1306549233
Provider Name (Legal Business Name): WENDY MOSTELLER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 13TH AVE STE 200
HUNTINGTON WV
25701-3840
US

IV. Provider business mailing address

43 OLD COUNTY 5 RD
SOD WV
25564-9000
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: