=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972316115
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHELYAN DENTAL, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2025
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15081 MACCORKLE AVNENUE
-----------------------------------------------------
City | CABIN CREEK
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 681-221-7313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 B ST
-----------------------------------------------------
City | SAINT ALBANS
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25177-1806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-415-6474
-----------------------------------------------------
Fax | 304-744-8245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | STEVEN AMOS GHAREEB
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 304-610-9973
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------