| NPI | 1104663962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS L CANNON Rcm 757-869-9916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-07-10 |
| Last Update Date | 2024-07-10 |