| NPI | 1528272499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE S WYMAN President 703-569-4040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: VA 0401004973) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-08-22 |