NPI | 1043717457 |
---|---|
Entity Type | Organization |
Authorized Contact | PATTY LYNN HEBERLING Office Manager 757-436-0026 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401006063) |
Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: VA 0401006063) |
Enumeration Date | 2018-04-11 |
Last Update Date | 2018-08-28 |