| NPI | 1174093835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI A WASHNIGTON Credentialing 757-595-8964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2018-11-26 |