| NPI | 1134276819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAHMIKA HARRIS Office Manager 703-492-0080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401006895) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2020-08-22 |