| NPI | 1235517962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA MOODY Regional Manager 540-710-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2015-05-14 |