| NPI | 1194013474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLA J PISMENY Practice Administrator 757-488-1285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401008978) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2011-07-20 |