| NPI | 1093081143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA ANGUS Member 804-794-6893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401411855) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2012-03-22 |