Organization
HAIRSTON FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEAH RAE HAIRSTON DDS (OWNER DENTIST)
(304) 542-7860
Entity
Organization
Contact information
Practice address
255 WASHINGTON ST, RAVENSWOOD, WV 26164-1874
(304) 273-5301
Mailing address
255 WASHINGTON ST, RAVENSWOOD, WV 26164-1874
(304) 273-5301
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
WV4152
WV
Other
Enumeration date
03/09/2017
Last updated
03/09/2017
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