| NPI | 1114930310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK EDWARD GOLUB President 703-765-3366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401005546) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2020-08-22 |