| NPI | 1205073087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDY A.T. MA Dds/ Vice President 703-527-3888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401410721) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: VA 0401411232) |
| 1223G0001X Dentist General Practice (Licence: VA 0401410983) | |
| 1223G0001X Dentist General Practice (Licence: VA 0401410421) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0401412250) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: VA 0401412334) | |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2009-01-15 |