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4502 Maccorkle Ave Se Suite C Charleston WV 25304-1835 | |
| (304) 926-9260 | |
| (304) 926-9266 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 4502 Maccorkle Ave Se, Charleston, West Virginia |
| Authorized Official Name and Position | Don E Skaff (OWNER) |
| Authorized Official Contact | 3049269260 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4502 Maccorkle Ave Se Suite C Charleston WV 25304-1835 Ph: (304) 926-9260 | 4502 Maccorkle Ave Se Suite C Charleston WV 25304-1835 Ph: (304) 926-9260 |
| NPI Number | 1740621036 |
|---|---|
| Provider Enumeration Date | 07/15/2013 |
| Last Update Date | 07/15/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740621036 | NPI | - | NPPES |
| 0138545000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 2869 (West Virginia) | Primary |
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