| Hobert L. Mack, D.d.s., Inc | |
|
505 Stratton St Logan WV 25601-3806 | |
| (304) 752-3563 | |
| (304) 752-3148 |
| Full Name | Hobert L. Mack, D.d.s., Inc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 505 Stratton St, Logan, West Virginia |
| Authorized Official Name and Position | Kristina L Fleming (SECRETARY) |
| Authorized Official Contact | 3047523563 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hobert L. Mack, D.d.s., Inc 505 Stratton St Logan WV 25601-3806 Ph: (304) 752-3563 | Hobert L. Mack, D.d.s., Inc 505 Stratton St Logan WV 25601-3806 Ph: (304) 752-3563 |
| NPI Number | 1780802975 |
|---|---|
| Provider Enumeration Date | 04/23/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780802975 | NPI | - | NPPES |
| 3810006947 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2429 (West Virginia) | Primary |
Jeffrey S. Mccoy Susan Fowler Goodwin D.d.s. Inc. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 127 Prosperity Ln, Logan, WV 25601 Phone: 304-752-4801 Fax: 304-752-4825 |