| NPI | 1467543900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA LANETTE MUNDY Practice Administrator 540-898-8616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401007440) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-08-22 |