| NPI | 1023103751 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUY GLICKSON LEVY Dentist 757-877-9281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401006910) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |