| NPI | 1205045648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER WAITKUS Doctor 757-340-9020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 4032) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-08-22 |