| NPI | 1235305152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA CARSON Controller 804-330-0508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401007026) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2022-09-21 |