Healthcare Provider Details

I. General information

NPI: 1740732361
Provider Name (Legal Business Name): WEST VIRGINIA UNIVERSITY DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MED CENTER DRIVE
MORGANTOWN WV
26506
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: DR. ANTHONY BORGIA
Title or Position: DEAN
Credential: DDS
Phone: 304-293-1000