| NPI | 1285776542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILSON TYLER MISTR Owner 540-545-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401008715) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401008618) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-08-22 |