| NPI | 1003352931 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BASIONY HAGAR Doctor 804-520-1741 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401412257) |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2017-01-17 |