| NPI | 1124913561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIM ERVIL Owner 804-615-9682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental |
| Additional Taxonomies | 1223D0004X Dentist Dentist Anesthesiologist |
| 1223P0221X Dentist Pediatric Dentistry | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery | |
| 207L00000X Anesthesiology | |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2025-06-09 |