| NPI | 1023162260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTI BEJARANO Regional Manager 540-710-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401008083) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-08-22 |