| NPI | 1053171462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN GENE BRIESEMEISTER Owner 757-929-7100 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2024-03-21 |