| NPI | 1265782361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANA DENISE GRAHAM-MONTAQE Owner/Pediatric Dentist 866-977-4787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401411505) |
| Enumeration Date | 2012-09-16 |
| Last Update Date | 2012-09-16 |