Healthcare Provider Details

I. General information

NPI: 1578655452
Provider Name (Legal Business Name): CHARLES STEVEN MCELFISH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 HUNT CLUB DR
RIDGELEY WV
26753-7567
US

IV. Provider business mailing address

35 HUNT CLUB DR
RIDGELEY WV
26753-7567
US

V. Phone/Fax

Practice location:
  • Phone: 304-726-4562
  • Fax: 304-726-7244
Mailing address:
  • Phone: 304-726-4562
  • Fax: 304-726-7244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2895
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: