| NPI | 1396020848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH QIU Owner 703-798-3964 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 401102428) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 401411116) |
| 122300000X Dentist (Licence: VA 401412557) | |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2011-10-17 |