| NPI | 1265547947 |
|---|---|
| Doing Business As | CHANTILLY ORAL SURGERY |
| Entity Type | Organization |
| Authorized Contact | KAITI ROSE GRIM Administrative Director 703-668-9494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401006304) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401410305) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2013-06-27 |