| NPI | 1366058604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY C MCVAY Office Assistant 434-792-4046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2020-09-22 |