Healthcare Provider Details

I. General information

NPI: 1104278209
Provider Name (Legal Business Name): VALLEY HEALTH WAYNE DENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 MCGINNIS DRIVE
WAYNE WV
25570
US

IV. Provider business mailing address

PO BOX 1680
HUNTINGTON WV
25717-1680
US

V. Phone/Fax

Practice location:
  • Phone: 304-272-5136
  • Fax: 304-272-3807
Mailing address:
  • Phone: 304-697-1396
  • Fax: 304-697-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARY-BETH BRUBECK
Title or Position: VICE PRESIDENT OF FINANCE / CFO
Credential:
Phone: 304-525-3334