Healthcare Provider Details

I. General information

NPI: 1669852323
Provider Name (Legal Business Name): CALEB LEE SIZEMORE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E MAIN ST
WHITE SULPHUR SPRINGS WV
24986-2338
US

IV. Provider business mailing address

304 E MAIN ST P.O. BOX 399
WHITE SULPHUR SPRINGS WV
24986-2338
US

V. Phone/Fax

Practice location:
  • Phone: 540-691-9710
  • Fax:
Mailing address:
  • Phone: 304-536-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4168
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: