# BRUCETON DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215385935
- **Authorized official:** SCOTT REO OKUBO DDS (DDS/OWNER)
- **Authorized official phone:** (304) 379-8101

## Contact information

- **Practice address:** 128 GREEN STREET, BRUCETON MILLS, WV 26525
- **Practice address phone:** (304) 379-8101
- **Practice address fax:** (304) 379-8102
- **Mailing address:** PO BOX 147, BRUCETON MILLS, WV 26525-0147
- **Mailing address phone:** (304) 379-8101
- **Mailing address fax:** (304) 379-8102

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | WV2976 | WV | Yes |

## Other

- **Enumeration date:** 06/03/2016
- **Last updated:** 06/03/2016