| NPI | 1215292255 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL ELLIS PRILLAMAN Owner 757-547-2820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2012-07-05 |