| NPI | 1295930097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD L TANKERLSEY Partner 757-595-8964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401003791) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2012-04-04 |