Healthcare Provider Details

I. General information

NPI: 1366000259
Provider Name (Legal Business Name): L&B DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 GEORGE WASHINGTON HWY
THORNTON WV
26440-7231
US

IV. Provider business mailing address

3126 GEORGE WASHINGTON HWY
THORNTON WV
26440-7231
US

V. Phone/Fax

Practice location:
  • Phone: 304-793-4653
  • Fax: 304-892-3943
Mailing address:
  • Phone: 304-793-4653
  • Fax: 304-892-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LYNNEL BEAUCHESNE
Title or Position: PRIMARY OWNER
Credential: DDS
Phone: 304-290-1997