| NPI | 1467606608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLE P LIVESAY Office Manager 540-785-5885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 7431) |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2008-11-14 |