| NPI | 1548816598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER GUST WOLBERG Owner President Dentist 804-379-9375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2019-08-15 |