| NPI | 1194173922 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL C SHUCK President 757-345-2295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401411834) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2016-06-02 |