| Dr. Russell Tritapoe Dds Pllc | |
|
58 Presidents Street Fort Ashby WV 26719-0738 | |
| (304) 298-3501 | |
| (304) 298-3406 |
| Full Name | Dr. Russell Tritapoe Dds Pllc |
|---|---|
| Speciality | Dentist |
| Location | 58 Presidents Street, Fort Ashby, West Virginia |
| Authorized Official Name and Position | Russell Tritapoe (OWNER) |
| Authorized Official Contact | 3042983501 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Russell Tritapoe Dds Pllc Po Box 738 Fort Ashby WV 26719-0738 Ph: (304) 298-3501 | Dr. Russell Tritapoe Dds Pllc 58 Presidents Street Fort Ashby WV 26719-0738 Ph: (304) 298-3501 |
| NPI Number | 1609250729 |
|---|---|
| Provider Enumeration Date | 07/18/2015 |
| Last Update Date | 07/18/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609250729 | NPI | - | NPPES |
| 3810025875 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 3997 (West Virginia) | Primary |