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General NPI Number Information
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NPI Number | 1720871296
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Entity Type | Organization
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Legal Business Name | BRUCETON MILLS FAMILY DENTISTRY
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 10 MEMORIAL DR
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City | BRUCETON MILLS
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State | WV
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Zip | 26525-9415
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Country | US
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Telephone | 304-903-9062
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Fax |
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Provider Business Mailing Address
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Address Line | 210 SANTORINI AVE
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City | MORGANTOWN
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State | WV
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Zip | 26508-5986
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Country | US
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Telephone | 304-276-3225
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. SAVANNAH LYNN BRYNER
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Credential | DDS
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Telephone | 304-276-3225
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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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