| NPI | 1336561315 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY HODGE Owner 571-921-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401413527) |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2014-01-10 |