| NPI | 1407027402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLA MARIE KEENE Dental Practitioner 276-676-0070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401007589) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2008-10-15 |