Healthcare Provider Details

I. General information

NPI: 1033132402
Provider Name (Legal Business Name): PHILIPD HIGH, DDS., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 MOUNT DE CHANTAL RD
WHEELING WV
26003-6332
US

IV. Provider business mailing address

1203 MT DECHANTAL RD
WHEELING WV
26003
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-5671
  • Fax: 304-242-0641
Mailing address:
  • Phone: 304-242-5671
  • Fax: 304-242-0641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number2039
License Number StateWV

VIII. Authorized Official

Name: MS. JO DONAHUE
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-242-0641