| NPI | 1275125809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROLIN S HENRY Member 703-638-1420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2021-02-04 |