| NPI | 1295520732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMEELAH JOHNSON Manager 571-320-0150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health |
| Additional Taxonomies | 261QR0208X Clinic/Center, Radiology, Mobile |
| Enumeration Date | 2025-04-14 |
| Last Update Date | 2025-07-17 |