| NPI | 1194075341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRAVEENA SEETHARAM SHETTY Owner 703-338-9736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 26239) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2012-09-14 |