=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801610795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARLES E. MCELFISH, DDS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2024
-----------------------------------------------------
Last Update Date | 11/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3979 TEAYS VALLEY RD
-----------------------------------------------------
City | HURRICANE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25526-9082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-757-7590
-----------------------------------------------------
Fax | 304-757-7590
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1127
-----------------------------------------------------
City | SCOTT DEPOT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25560-1127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-757-7590
-----------------------------------------------------
Fax | 304-757-4108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. CHARLES EDWARD MCELFISH
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 304-757-7590
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------