| NPI | 1447585997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND FRANK MALLINAK Owner 276-632-2189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401005236) |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2009-10-15 |