| NPI | 1154692408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DOE Managing Clinical Director 703-777-5939 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401413091) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2012-01-18 |