| NPI | 1205059441 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN M CLARKE President 434-296-8043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401411048) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401004067) |
| 122300000X Dentist (Licence: VA 0401005608) | |
| 122300000X Dentist (Licence: VA 0401007444) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2020-08-22 |