| NPI | 1104038546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANAKA SRIRAM Dentist 703-255-2326 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401007621) |
| Enumeration Date | 2007-05-06 |
| Last Update Date | 2020-08-22 |