| NPI | 1235582974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANJA MANOJLOVIC Practice Administrator 757-467-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401008873) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2016-07-18 |