# STEVE CHILDRESS II, DDS

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

## Provider details

- **NPI number:** 1922578764
- **Authorized official:** DR. STEVEN WAYNE CHILDRESS II DDS (OWNER/DENTIST)
- **Authorized official phone:** (304) 255-0439

## Contact information

- **Practice address:** 402 CARRIAGE DR, BECKLEY, WV 25801-2806
- **Practice address phone:** (304) 255-0439
- **Mailing address:** 402 CARRIAGE DR, BECKLEY, WV 25801-2806
- **Mailing address phone:** (304) 255-0439

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 12/04/2018
- **Last updated:** 12/04/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1548209869 | — | WV |
| 01 | — | 1588145429 | NATIONAL PLAN & PROVIDER ENUMERATION SERVICE | WV |