| NPI | 1215100524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN DONOHUE Dentist 703-978-1446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401411397) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2008-04-08 |