| NPI | 1447069182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER SHIM Manager 703-403-5419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2025-01-07 |
| Last Update Date | 2025-01-07 |