| NPI | 1548747090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW WALLACE JOOSSE Owner 757-876-9593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2018-12-04 |