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General NPI Number Information
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NPI Number | 1306490552
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Entity Type | Organization
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Legal Business Name | MOUNTAINEER DENTAL CO.
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Dates
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Enumeration Date | 07/26/2019
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Last Update Date | 07/26/2019
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Provider Practice Location Address
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Address Line | 6 COLUMBIA ST
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City | PHILIPPI
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State | WV
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Zip | 26416-1620
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Country | US
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Telephone | 304-457-0590
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Fax | 304-457-0952
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Provider Business Mailing Address
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Address Line | PO BOX 960
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City | PHILIPPI
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State | WV
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Zip | 26416-0960
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Country | US
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Telephone | 304-457-0590
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Fax | 304-457-0592
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN PYLE
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Credential | DDS
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Telephone | 304-457-0590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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