| NPI | 1548554850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT RUSNAK Owner 804-262-1060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2011-06-03 |