| NPI | 1114378544 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMER KHATTAB Consultant 703-348-8070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401413570) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414531) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2017-05-04 |