| NPI | 1114447703 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK D NEWMAN President 757-965-5194 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0443000025) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2022-07-21 |