| NPI | 1437376605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ANN ROBERTSON Accountant Administrator 434-923-0303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-08-22 |