| NPI | 1558928135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY PALMER Manager 703-433-0234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2019-06-03 |