| NPI | 1124292131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON SCOTT Owner 757-825-6280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 5160) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2008-04-22 |