| NPI | 1023568995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE O DAVIS Business Administrator 757-369-1754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2019-06-24 |