| NPI | 1225465131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE HICKERSON Office Manager 571-293-0244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401412920) |
| Enumeration Date | 2013-10-09 |
| Last Update Date | 2013-10-09 |