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General NPI Number Information
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NPI Number | 1124521448
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Entity Type | Individual
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Provider Name | BRYAN SCOTT VAN DINE
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Gender | Male
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1500 GRAND CENTRAL AVE
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City | VIENNA
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State | WV
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Zip | 26105-1079
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Country | US
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Telephone | 304-422-2625
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Fax |
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Provider Business Mailing Address
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Address Line | 2720 OXBOW ST
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City | BELPRE
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State | OH
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Zip | 45714-9549
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Country | US
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Telephone | 740-336-4350
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number |
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License Number State |
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