| NPI | 1235695743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER THOMAS VAUGHAN Owner 804-625-4064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Additional Taxonomies | 1223X2210X Dentist, Orofacial Pain |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2023-03-30 |