| NPI | 1497105100 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL KOSTROV Doctor/Owner 202-466-3599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC 1000589) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2016-06-14 |