| NPI | 1235786328 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL WILBUR PHILLIPS Owner 202-463-2090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2019-08-22 |