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General NPI Number Information
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NPI Number | 1710518543
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Entity Type | Organization
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Legal Business Name | TKR ORAL MAXILLOFACIAL SURGEONS CORPORATION
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 01/30/2020
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Provider Practice Location Address
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Address Line | 914 JOHNSTOWN RD
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City | BECKLEY
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State | WV
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Zip | 25801-4938
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Country | US
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Telephone | 681-207-3959
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Fax | 681-207-3958
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Provider Business Mailing Address
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Address Line | 914 JOHNSTOWN RD
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City | BECKLEY
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State | WV
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Zip | 25801-4938
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Country | US
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Telephone | 681-207-3959
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Fax | 681-207-3958
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRSTAL KAY THOMPSON
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Credential | DDS
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Telephone | 304-731-6688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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