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General NPI Number Information
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NPI Number | 1164299772
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Entity Type | Organization
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Legal Business Name | OCEANA DENTAL CENTER PLLC
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 1427 COOK PARKWAY
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City | OCEANA
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State | WV
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Zip | 24870-2487
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Country | US
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Telephone | 304-682-6104
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Fax | 304-682-6157
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Provider Business Mailing Address
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Address Line | PO BOX 1438
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City | OCEANA
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State | WV
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Zip | 24870-1438
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Country | US
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Telephone | 304-682-6104
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Fax | 304-682-6104
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL B MOORE
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Credential | DDS
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Telephone | 304-890-3465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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