| NPI | 1124579396 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN R. LUBBE Vice President 804-739-0963 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2023-12-12 |