Organization
COUNTRY CLUB DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NADIA MARDMOMEN DDS (MEMBER)
(304) 672-9994
Entity
Organization
Contact information
Practice address
1520 COUNTRY CLUB RD, FAIRMONT, WV 26554-1353
(304) 363-9160
Mailing address
80 GARDEN CIR, BRIDGEPORT, WV 26330-1367
(304) 672-9994
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/18/2025
Last updated
11/18/2025
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