| NPI | 1437767670 |
|---|---|
| Doing Business As | SOUTH SIDE DENTAL CENTER |
| Entity Type | Organization |
| Authorized Contact | BRAD SPANO President 434-984-8828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2020-07-14 |