| NPI | 1336611185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE GOEHRING Business Manager 703-360-8660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2018-12-18 |