| NPI | 1467008250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE J ROBINSON Office Manager 757-378-0906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery |
| Additional Taxonomies | 122300000X Dentist |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics | |
| Enumeration Date | 2019-08-16 |
| Last Update Date | 2019-08-16 |