| NPI | 1063799765 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AYESHA SULTAN Dentist 703-220-9984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 0401412555) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2011-11-08 |