| NPI | 1255841433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY JOE SHEPPARD Owner 540-563-1660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401413481) |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2017-10-02 |