| NPI | 1386196343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN EDWARDS Principal Dentist 804-350-0994 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA 0401415285) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2016-10-25 |