| NPI | 1497957286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER WAITKUS Doctor 757-826-8511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: VA 0401004032) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-08-22 |