| NPI | 1104932946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL EDWARD GROSSO Owner/Dentist 703-532-0072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401410772) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-08-22 |