| NPI | 1548477649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE O DAVIS Business Administrator 757-369-1754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401410912) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2019-05-29 |