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General NPI Number Information
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NPI Number | 1316685977
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Entity Type | Organization
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Legal Business Name | CENTRAL WEST VIRGINIA SLEEP SOLUTIONS PLLC
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 832 BROAD ST
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-1758
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Country | US
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Telephone | 304-872-3919
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Fax | 304-872-4943
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Provider Business Mailing Address
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Address Line | 832 BROAD ST
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-1758
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Country | US
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Telephone | 304-872-3919
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Fax | 304-872-4943
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN C LUCKY
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Credential | DDS
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Telephone | 304-872-3919
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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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