| NPI | 1164436804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES HOWELL NELSON Dentist 703-361-2141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: VA 0401007907) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2017-03-01 |