| NPI | 1073065173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS WALDROP Program Director 804-828-4867 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0442000290) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2016-10-25 |