| NPI | 1124164108 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA SMITH Office Administrator 703-425-5010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2020-08-22 |