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General NPI Number Information
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NPI Number | 1710067269
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Entity Type | Organization
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Legal Business Name | CRUIKSHANK & MATHIAS DENTISTS INC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 215 S LOUISIANA AVENUE
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City | MARTINSBURG
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State | WV
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Zip | 25401-2037
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Country | US
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Telephone | 304-267-8702
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Fax | 304-263-2787
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Provider Business Mailing Address
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Address Line | 215 S LOUISIANA AVENUE
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City | MARTINSBURG
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State | WV
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Zip | 25401-2037
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Country | US
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Telephone | 304-267-8702
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Fax | 304-263-2787
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Authorized Official
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Title or Position | VICE PRESIDENT DENTIST
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Name | DR. JOHN MATTHEW MATHIAS
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Credential | DDS
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Telephone | 304-267-8702
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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 | WV 1794
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License Number State | WV
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