Organization
CHRISTINE L DEARTH DDS INC
Active
Other names
Kingwood Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE LAVONNE DEARTH DDS (OWNER PRESIDENT)
(304) 329-3142
Entity
Organization
Contact information
Practice address
430 MORGANTOWN ST, KINGWOOD, WV 26537
(304) 329-3142
(304) 329-0700
Mailing address
430 MORGANTOWN ST, KINGWOOD, WV 26537
(304) 329-3142
(304) 329-0700
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3416
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104022
UNITED CONCORDIA
WV
05
—
4040010000
—
WV
Enumeration date
02/08/2006
Last updated
08/22/2020
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