| NPI | 1376928739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISTY DAWN HOGGARD Practice Manager 757-498-7878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401412534) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2015-07-28 |