| NPI | 1497964183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOJDEH KHALILI S Corp President 703-212-0400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401007490) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-08-22 |