| NPI | 1558640946 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE HAROLD UTTERBACK Secretary 757-456-0734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: VA VA 0401007295) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental (Licence: VA VA 0401007145) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2011-08-16 |