| NPI | 1124322169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID PAINO President 703-281-7104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 05322) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: VA 401411121) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2021-11-04 |