| NPI | 1548540925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNDI C. RILEY Practice Administrator 434-385-7707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401008244) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401005655) |
| 122300000X Dentist (Licence: VA 0401413248) | |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2011-08-17 |