| NPI | 1558850776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANLEY LEROY CHICKEY President 757-481-3305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401005366) |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2018-06-16 |