| NPI | 1124672092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN HOWARD Credentialing Specialist 757-576-5479 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2019-07-30 |