| NPI | 1265813042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WILL Shareholder 434-817-1817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414088) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413819) |
| 122300000X Dentist (Licence: VA 0401412570) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: VA 0401412934) | |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: VA 0401413770) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401410463) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 753148626) | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2015-06-17 |