| NPI | 1477921419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN MARIE WILSON Executive Assistant 540-419-9422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 9187494-9921) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2015-09-08 |