| NPI | 1194972497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY D FORD Vice President Of Operations 757-595-6224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401411261) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2008-08-19 |