| NPI | 1306371737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES JELINEK Owner 540-628-2175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401006730) |
| Additional Taxonomies | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: VA 0401006730) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2017-04-24 |