| NPI | 1053604512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS ALAN HERESI Dentist 540-371-6929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401412533) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2011-05-17 |