Provider Demographics
NPI:1801833629
Name:OPIMO, REGINALD S (DDS)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:S
Last Name:OPIMO
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 1:2519 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1614
Mailing Address - Country:US
Mailing Address - Phone:304-525-0560
Mailing Address - Fax:304-525-5768
Practice Address - Street 1:2519 3RD AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1614
Practice Address - Country:US
Practice Address - Phone:304-525-0560
Practice Address - Fax:304-525-5768
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV35101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice