| NPI | 1306096607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLEN RAY MILLER President 703-753-7077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401008691) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2008-09-23 |