| NPI | 1003934464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID J LARSON President 804-323-3944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401006445) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401006446) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-08-22 |