| NPI | 1083802607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD ROSS TESTERMAN Dentist 540-885-1631 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: VA 0401005809) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2007-10-09 |