| NPI | 1508301789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN GREENE Practice Administrator 757-962-6769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 2017-260772-R) |
| Enumeration Date | 2016-12-27 |
| Last Update Date | 2016-12-27 |