| NPI | 1427319300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TATJANA MANOJLOVIC CEO 757-623-0283 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401008873) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401412033) |
| 1223G0001X Dentist General Practice (Licence: VA 0401412834) | |
| 1223G0001X Dentist General Practice (Licence: VA 0401413140) | |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2016-05-13 |