Healthcare Provider Details

I. General information

NPI: 1720097637
Provider Name (Legal Business Name): WEST VIRGINIA UNIVERSITY DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MED CENTER DR
MORGANTOWN WV
26506-0000
US

IV. Provider business mailing address

PO BOX 1587
MORGANTOWN WV
26507-1587
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-2240
  • Fax: 304-293-7646
Mailing address:
  • Phone: 304-293-2240
  • Fax: 304-293-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DIANE HESS
Title or Position: MANAGER,DENTAL BILLING
Credential:
Phone: 304-293-2240