| NPI | 1538464524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLENA WILLIS KENNERLY President 571-278-3680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: DC DEN10000484) |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2011-01-21 |