NPI | 1174508196 |
---|---|
Entity Type | Organization |
Authorized Contact | J. BRIAN QUEEN Owner/Dentist 703-689-2480 |
Organization Subpart ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401007661) |
Enumeration Date | 2005-12-13 |
Last Update Date | 2014-02-06 |