| NPI | 1326230772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW REED BROKAW President/Secretary/Owner 804-270-6200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401008695) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2014-11-04 |