| NPI | 1508697418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS L CANNON Rcm 757-327-4843 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2024-08-12 |
| Last Update Date | 2024-08-12 |