| NPI | 1205931409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND C BAKER Owner 434-845-1121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401004767) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0438000105) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2020-08-22 |