| NPI | 1417146044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG W.T. ESTRADA President 757-548-1611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 07715) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 06969) |
| 1223G0001X Dentist, General Practice (Licence: VA 10774) | |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2007-10-19 |