| NPI | 1124693882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN NELSON Orthodontist 703-260-7895 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-05-25 |