| NPI | 1093074189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG W.T. ESTRADA Dentist 757-548-1611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 006969) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 007715) |
| 122300000X Dentist (Licence: VA 410774) | |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2012-05-09 |