| NPI | 1104172147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ELIZABETH MORGAN Owner 703-723-5900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401411481) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2012-07-27 |