| NPI | 1386654127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDIE SUSAN COHEN Office Manager 757-548-3238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 7166) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2020-08-22 |