| NPI | 1285040501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEAL KRAVITZ Owner 571-206-1395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 401411350) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: VA 040143294) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2017-03-31 |