| NPI | 1114399276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE GRISETTI Director Of Operational Support 540-224-5352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2023-05-22 |