| NPI | 1225425465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEUXS CARROLL Owner 703-388-2889 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: VA 040142450) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2015-06-30 |