| NPI | 1386839918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON M MARTIN Dentist 757-930-9100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA VA7853) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2007-09-06 |