| NPI | 1437236932 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN E WIGGINS Dr President Of Corporation 757-397-3296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401005435) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401002941) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |