| NPI | 1265929913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA SHAWVER Practice Manager 757-424-2672 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery |
| Enumeration Date | 2018-04-18 |
| Last Update Date | 2024-04-23 |