| NPI | 1467903179 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL ALAN CLEVELAND Dentist/Owner 804-794-4564 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401006305) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2016-10-18 |