| NPI | 1497694749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN DANIEL KIELY President/CEO 757-784-2830 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2026-03-25 |
| Last Update Date | 2026-03-25 |