| NPI | 1013304401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETTE LEIGH JOHANNES Treatment COO Rdinator 703-230-6784 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: VA 0401008946) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2015-04-23 |