| NPI | 1104209345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FIORELLA CARRILLO Patient Coordinator 804-754-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401410612) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-07-07 |