Provider Demographics
NPI:1801069042
Name:TEAYS DENTAL CARE
Entity type:Organization
Organization Name:TEAYS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUTO
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-757-1000
Mailing Address - Street 1:3860 TEAYS VALLEY RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9772
Mailing Address - Country:US
Mailing Address - Phone:304-757-1000
Mailing Address - Fax:
Practice Address - Street 1:3860 TEAYS VALLEY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9772
Practice Address - Country:US
Practice Address - Phone:304-757-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV3511122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty