| NPI | 1134504574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA COLUCCI Credentials Coordinator 757-314-7944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN21180) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2015-08-13 |