| NPI | 1023207792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SU-EN C THLICK Dentist/ Owner 703-670-2114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 040108779VA) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2007-10-18 |