Provider Demographics
NPI:1033225131
Name:STARCHER, JOHN EVERETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EVERETT
Last Name:STARCHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 BIG TYLER ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313
Mailing Address - Country:US
Mailing Address - Phone:304-776-2500
Mailing Address - Fax:304-776-2906
Practice Address - Street 1:5509 BIG TYLER ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313
Practice Address - Country:US
Practice Address - Phone:304-776-2500
Practice Address - Fax:304-776-2906
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0133302000Medicaid
443865OtherUNITED CONCORDIA
443865OtherBLUE CROSS BLUE SHIELD