Organization
HOBERT L. MACK, D.D.S., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTINA L FLEMING (SECRETARY)
(304) 752-3563
Entity
Organization
Contact information
Practice address
505 STRATTON ST, LOGAN, WV 25601-3806
(304) 752-3563
(304) 752-3148
Mailing address
505 STRATTON ST, LOGAN, WV 25601-3806
(304) 752-3563
(304) 752-3148
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2429
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810006947
—
WV
Enumeration date
04/23/2007
Last updated
08/22/2020
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