| NPI | 1366818841 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON T LIPSCOMB Dentist 804-986-4058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: VA 0401410585) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2015-08-19 |