Individual provider · NPI-1

Dr. Michele Agusto, DDS

Dentist, Periodontics · Morgantown, WV

NPI number1245735224
StatusActive
Last updated in NPPESMar 29, 2018

Details

NPI
1245735224
Entity type
Individual (NPI-1)
Name
Dr. Michele Agusto
Credential
DDS
Sex
Male
Sole proprietor
No
Enumeration date
Mar 29, 2018
Last updated
Mar 29, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223P0300X Dentist, PeriodonticsIP1701WVYes

Practice location

451 Suncrest Town Centre Dr
Morgantown, WV 26505-1814

Phone 304-293-5642

Mailing address

1233 Pineview Dr Apt 22
Morgantown, WV 26505-2786

Phone 304-413-5700

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