| NPI | 1285817775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRED A. KNAYSI Dentist 804-282-6005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: VA 0401005393) |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2007-12-07 |